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19957410-RR-34 | 19,957,410 | 23,037,934 | RR | 34 | 2168-09-24 16:39:00 | 2168-09-24 17:02:00 | EXAMINATION: UNILAT LOWER EXT VEINS
INDICATION: ___ year old woman with alcoholic cirrhosis found to have left ___
swelling// Eval for left ___ DVT
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the left lower extremity veins.
COMPARISON: Left lower extremity vein Doppler from ___
FINDINGS:
There is normal compressibility, flow, and augmentation of the left common
femoral, femoral, and popliteal veins. Normal color flow and compressibility
are demonstrated in the posterior tibial and peroneal veins.
There is normal respiratory variation in the common femoral veins bilaterally.
No evidence of medial popliteal fossa (___) cyst.
There is superficial soft tissue edema at the level of the left calf.
IMPRESSION:
No evidence of deep venous thrombosis in the left lower extremity veins.
|
19957410-RR-36 | 19,957,410 | 23,037,934 | RR | 36 | 2168-09-27 13:10:00 | 2168-09-27 17:23:00 | EXAMINATION: BILATERAL DIGITAL 2D DIAGNOSTIC MAMMOGRAM INTERPRETED WITH CAD
AND BILATERAL BREAST ULTRASOUND
INDICATION: ___ woman report of outside mammogram with new
calcifications, per OMR surgical note. The patient has a history of cirrhosis
and is being evaluated for liver transplant.
Family history of breast cancer sister, age not provided.
COMPARISON: No outside imaging or scanned reports are available at this time.
TECHNIQUE: Bilateral CC and MLO, left lateral and and right magnification CC
and ML views were obtained at this time. Computer aided detection was
utilized and assisted with interpretation. Bilateral limited ultrasound was
performed and selected images obtained.
FINDINGS:
Tissue density: C- The breast tissue is heterogeneously dense which may
obscure detection of small masses.
Right: There are multiple indeterminate calcifications including
microcalcifications in the upper, central-outer breast at middle depth which
span 2.4 x 1.6 x 0.4 cm.
There is another group of punctate calcifications and microcalcifications seen
in the anterior right medial breast just above the mid nipple line. These are
less concerning compared to the larger group.
There is no suspicious dominant mass.
Comparison to prior studies would provide additional information.
Left: There is diffuse skin thickening and prominence of the trabecular
pattern consistent with marked edema. There is no suspicious dominant mass or
suspicious grouped calcifications.
BILATERAL BREAST ULTRASOUND:
Right: Targeted ultrasound of the right upper central breast was performed
which is without a discrete mass to target for ultrasound-guided core biopsy.
Limited whole breast ultrasound was also performed and is unremarkable.
Left: Targeted ultrasound of the left breast demonstrates diffuse skin
thickening measuring up to 1 cm with diffuse increased echogenicity of the
breast parenchyma consistent with diffuse edema. Limited whole breast
ultrasound is without a discrete mass target for biopsy.
IMPRESSION:
Right: Indeterminate calcifications in the upper central-outer breast at
middle depth spanning 2.4 cm. If priors are not available in an appropriate
time interval, consideration could be given to stereotactic core biopsy.
Management of the second group would depend on pathology of the first group,
as these are less concerning.
Left: Diffuse edema which is likely related to dependent edema.
RECOMMENDATION(S): Comparison to prior imaging is recommended. In the
absence of prior imaging and/or to facilitate the patient's care,
consideration could be given to stereotactic core biopsy of the right breast
calcifications, however, the patient's coagulopathy would have to be corrected
prior to stereotactic core biopsy.
NOTIFICATION: The findings of indeterminate right breast calcifications were
discussed with the patient and her husband (as well as the patient's daughter
by phone). They agree to proceed as per her care team. Preliminary email was
sent to her breast surgery care team.
BI-RADS: 0 Incomplete - Need Prior Mammograms for
Comparison.
|
19957410-RR-37 | 19,957,410 | 23,037,934 | RR | 37 | 2168-09-27 14:38:00 | 2168-09-27 17:23:00 | EXAMINATION: BILATERAL DIGITAL 2D DIAGNOSTIC MAMMOGRAM INTERPRETED WITH CAD
AND BILATERAL BREAST ULTRASOUND
INDICATION: ___ woman report of outside mammogram with new
calcifications, per OMR surgical note. The patient has a history of cirrhosis
and is being evaluated for liver transplant.
Family history of breast cancer sister, age not provided.
COMPARISON: No outside imaging or scanned reports are available at this time.
TECHNIQUE: Bilateral CC and MLO, left lateral and and right magnification CC
and ML views were obtained at this time. Computer aided detection was
utilized and assisted with interpretation. Bilateral limited ultrasound was
performed and selected images obtained.
FINDINGS:
Tissue density: C- The breast tissue is heterogeneously dense which may
obscure detection of small masses.
Right: There are multiple indeterminate calcifications including
microcalcifications in the upper, central-outer breast at middle depth which
span 2.4 x 1.6 x 0.4 cm.
There is another group of punctate calcifications and microcalcifications seen
in the anterior right medial breast just above the mid nipple line. These are
less concerning compared to the larger group.
There is no suspicious dominant mass.
Comparison to prior studies would provide additional information.
Left: There is diffuse skin thickening and prominence of the trabecular
pattern consistent with marked edema. There is no suspicious dominant mass or
suspicious grouped calcifications.
BILATERAL BREAST ULTRASOUND:
Right: Targeted ultrasound of the right upper central breast was performed
which is without a discrete mass to target for ultrasound-guided core biopsy.
Limited whole breast ultrasound was also performed and is unremarkable.
Left: Targeted ultrasound of the left breast demonstrates diffuse skin
thickening measuring up to 1 cm with diffuse increased echogenicity of the
breast parenchyma consistent with diffuse edema. Limited whole breast
ultrasound is without a discrete mass target for biopsy.
IMPRESSION:
Right: Indeterminate calcifications in the upper central-outer breast at
middle depth spanning 2.4 cm. If priors are not available in an appropriate
time interval, consideration could be given to stereotactic core biopsy.
Management of the second group would depend on pathology of the first group,
as these are less concerning.
Left: Diffuse edema which is likely related to dependent edema.
RECOMMENDATION(S): Comparison to prior imaging is recommended. In the
absence of prior imaging and/or to facilitate the patient's care,
consideration could be given to stereotactic core biopsy of the right breast
calcifications, however, the patient's coagulopathy would have to be corrected
prior to stereotactic core biopsy.
NOTIFICATION: The findings of indeterminate right breast calcifications were
discussed with the patient and her husband (as well as the patient's daughter
by phone). They agree to proceed as per her care team. Preliminary email was
sent to her breast surgery care team.
BI-RADS: 0 Incomplete - Need Prior Mammograms for
Comparison.
|
19957410-RR-38 | 19,957,410 | 23,037,934 | RR | 38 | 2168-09-29 00:31:00 | 2168-09-29 02:46:00 | EXAMINATION: concern for post-paracentesis bleed
INDICATION: ___ year old woman with HCV/ETOH cirrhosis c/b EV s/p banding p/w
liver failure undergoing transplant eval, course c/b sepsis ___ VRE bacteremia
with GI bleeding; underwent bedside paracentesis today, now with H/H drop
9.7->8.5- concern for possible post-paracentesis bleed// concern for
post-paracentesis bleed
TECHNIQUE: MDCT axial images were acquired through the abdomen and pelvis
without and with intravenous contrast administration in arterial and portal
venous phase.
Oral contrast was not administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
COMPARISON: ___ CT abdomen and pelvis
FINDINGS:
Lungs: The visualized lung bases demonstrate bibasilar atelectasis. A
ground-glass opacity is seen in the right middle lobe, abutting the major
fissure is new compared to the prior exam but likely related to atelectasis.
There are no pleural effusions.
Liver: The liver is shrunken with a nodular contour compatible with a
cirrhotic morphology. No suspicious focal liver lesions identified.
Biliary: There is no intrahepatic or extrahepatic bile duct dilatation. The
gallbladder contains multiple tiny gallstones in the neck. No evidence of
cholecystitis.
Spleen: The spleen is enlarged and measures 14.6 cm. Peripheral wedge-shaped
hypodensities are again seen, consistent with small infarcts, stable since
previously. There is revisualization of the stable small arterially enhancing
lesions, likely small hemangiomas.
Pancreas: The pancreatic parenchyma enhances homogeneously.. No main duct
dilation noted..
Adrenal glands: There are no adrenal nodules.
Urinary: The kidneys are unremarkable. There is no hydronephrosis.
Pelvis: The urinary bladder is collapsed and is not well assessed. The distal
ureters are unremarkable. There is a moderate amount of simple free fluid in
the pelvis.
Gastrointestinal: The distal tip of the enteric tube is seen in the proximal
jejunum. No bowel obstruction.. Extensive periesophageal varices are seen in
the lower mediastinum.
Vascular: There are mild atherosclerotic calcifications of the abdominal
aorta. Multiple portosystemic varices are seen, including large paraesophageal
varices.
Stable previously suspected nonocclusive portal vein thrombosis of the portal
confluence, series 303, image 60. There is narrowing of the intrahepatic
portal veins without thrombosis. A recanalized umbilical vein noted.
The hepatic veins are patent.
No active extravasation to suggest active bleeding.
Lymph nodes: There is no size significant lymph nodes.
Bone and soft tissues: There is no suspicious bone lesion.
There is diffuse anasarca.
No evidence of intra-abdominal hemorrhage.
There is a small amount of air in the subcutaneous tissues in the left flank,
along with new subcutaneous fluid likely due to leakage from the ascites. No
abdominal or pelvic wall hematoma seen.
IMPRESSION:
1. No evidence of intra-abdominal hemorrhage or active extravasation.
2. New subcutaneous fluid within the left flank is likely related to leakage
of ascites fluid from the site of paracentesis with overlying subcutaneous
edema. No hematoma noted at this site. Persistent moderate volume ascites
with CT Hounsfield unit demonstrating simple fluid.
3. Cirrhotic morphology of the liver without a focal liver lesion.
4. Stable previously described nonocclusive portal vein thrombosis. Large
periesophageal varices in the lower mediastinum. Rectal wall and perirectal
varices; recanalized umbilical vein and perigastric varices are also noted.
5. Splenic infarcts are again seen on today's examination and are stable.
6. Uncomplicated cholelithiasis.
7. New non-specific ground-glass opacity in the right middle lobe abutting
the fissure, could be infectious or inflammatory in nature.
|
19957410-RR-39 | 19,957,410 | 23,037,934 | RR | 39 | 2168-10-01 04:35:00 | 2168-10-01 11:44:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with decompensated EtOH/HCV cirrhosis c/b HE
and HRS, crackles bilaterally.// Interval change
COMPARISON: Chest radiographs from ___
FINDINGS:
Single supine portable AP view of the chest is provided
Patient is severely rotated limiting evaluation of the thorax. Low lung
volumes. Moderate cardiomegaly, grossly unchanged. There is interval
improvement of moderate pulmonary edema, now mild. Unchanged appearance of
retrocardiac opacity, likely atelectasis, however in the appropriate clinical
setting infectious process is difficult to exclude. Redemonstration of a
right-sided hemodialysis catheter which projects over the mid SVC. Stable
small left pleural effusion. No pneumothorax.
IMPRESSION:
Severe rotation limits evaluation of the thorax.
Interval improvement of pulmonary edema, now mild. Lung volumes are slightly
decreased compared to prior.
|
19957410-RR-40 | 19,957,410 | 23,037,934 | RR | 40 | 2168-10-03 03:53:00 | 2168-10-03 09:33:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with decompensated EtOH/HCV cirrhosis c/b HE
and HRS, crackles bilaterally.// Interval change Interval change
IMPRESSION:
Right internal jugular line tip terminates at the level of lower SVC. Type of
tube passes below the diaphragm terminating in the stomach. Heart size and
mediastinum are enlarged. Interstitial pulmonary edema is unchanged, mild.
No interval development of large pleural effusion.
|
19957410-RR-41 | 19,957,410 | 23,037,934 | RR | 41 | 2168-10-04 02:09:00 | 2168-10-04 09:05:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with liver failure// post op CXR
TECHNIQUE: Chest AP view
COMPARISON: ___
IMPRESSION:
Right-sided central line projects to the SVC. A new ET tube has been placed
in the interim which projects to the carina and needs to be pulled back.
There is complete atelectasis of the left lower lobe. The NG tube projects
below the left hemidiaphragm. There appear to be 2 NG tubes. The Swan-Ganz
catheter tip projects at the left main pulmonary artery. Radiopaque packing
material seen in the upper abdomen.
|
19957410-RR-45 | 19,957,410 | 23,037,934 | RR | 45 | 2168-10-04 09:47:00 | 2168-10-04 12:18:00 | EXAMINATION: DUPLEX DOPP ABD/PEL
INDICATION: evaluate liver
TECHNIQUE: Gray scale, color, and spectral Doppler evaluation of the abdomen
was performed.
COMPARISON: Correlation with CTA abdomen and pelvis from ___.
FINDINGS:
Liver: The hepatic parenchyma appears mildly edematous. No focal liver
lesions are identified. There is no ascites.
Bile ducts: There is no intrahepatic biliary ductal dilation. The common
hepatic duct measures 4 mm.
Gallbladder: The gallbladder is surgically absent.
Pancreas: The pancreas is obscured by overlying bowel gas.
Spleen: The spleen is not able to be adequately assessed due to bowel gas and
patient positioning.
Doppler evaluation:
The main portal vein is patent, with flow in the appropriate direction.
Main portal vein velocity is 55.4 cm/sec.
Right and left portal veins are patent, with antegrade flow.
The main hepatic artery is patent, with appropriate waveform.
Right, middle and left hepatic veins are patent, with appropriate waveforms.
Splenic vein and superior mesenteric vein were not able to be adequately
visualized.
IMPRESSION:
Satisfactory appearance of the transplant liver with patent hepatic
vasculature.
NOTIFICATION: The findings were discussed with ___, M.D. by
___, M.D. on the telephone on ___ at 12:20 pm, 30 minutes
after discovery of the findings.
|
19957410-RR-46 | 19,957,410 | 23,037,934 | RR | 46 | 2168-10-04 14:58:00 | 2168-10-04 16:13:00 | INDICATION: Post abdominal closure.
TECHNIQUE: Intraoperative abdominal images were obtained.
COMPARISON: None.
FINDINGS:
Multiple portable supine radiographs were obtained intraoperatively. Multiple
drains in clips are noted. No unintended radiopaque foreign body.
IMPRESSION:
No unexpected radiopaque foreign bodies.
NOTIFICATION: The findings were discussed with ___, M.D. by ___
___, M.D. on the telephone on ___ at 4:11 pm, 2 minutes after
discovery of the findings.
|
19957410-RR-47 | 19,957,410 | 23,037,934 | RR | 47 | 2168-10-04 21:25:00 | 2168-10-05 00:45:00 | EXAMINATION: Chest radiograph, portable AP supine.
INDICATION: Status post renal transplant.
COMPARISON: Earlier on the same day.
FINDINGS:
Endotracheal tube was retracted. It terminates about 3 cm above the carina.
There is still extensive atelectasis in the left lower lung, involving much of
ir perhaps even all of the left lower lobe including leftward shift. Two
orogastric tubes again course into the stomach. Pulmonary artery catheter
appears unchanged. Large-bore right internal jugular catheter again
terminates in the superior vena cava. Facial in mixed interstitial and hazy
opacities suggests mild vascular congestion, increased. There is a small
right-sided pleural effusion, as before. Pleural effusion is not excluded on
the left as a component of left basilar opacification.
IMPRESSION:
Persistent extensive left lower lung atelectasis, but retraction of
endotracheal tube. New mild process suggesting vascular congestion.
|
19957410-RR-48 | 19,957,410 | 23,037,934 | RR | 48 | 2168-10-05 08:46:00 | 2168-10-05 15:14:00 | EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN)
INDICATION: ___ year old woman DDLT// evaluate liver postop
TECHNIQUE: Grey scale, color and spectral Doppler ultrasound images of the
abdomen were obtained.
COMPARISON: Abdominal ultrasounds dated ___.
FINDINGS:
Liver echotexture is normal with focal fat adjacent to the falciform ligament.
There is no evidence of focal liver lesions or biliary dilatation. The common
bile duct measures 0.4 cm. There is no ascites, right pleural effusion, or
sub- or ___ fluid collections/hematomas.
The spleen measures 12.3 cm and has normal echotexture.
DOPPLER: The main hepatic arterial waveform is within normal limits, with
prompt systolic upstrokes and continuous antegrade diastolic flow. Peak
systolic velocity in the main hepatic artery is 84.1. Appropriate arterial
waveforms are seen in the right hepatic artery and the left hepatic artery
with resistive indices of 0.69, and 0.74, respectively. The main portal vein
and the right and left portal veins are patent with hepatopetal flow and
normal waveform. Appropriate flow is seen in the hepatic veins and the IVC.
IMPRESSION:
Patent hepatic vasculature with appropriate waveforms.
|
19957410-RR-49 | 19,957,410 | 23,037,934 | RR | 49 | 2168-10-05 08:47:00 | 2168-10-05 15:15:00 | EXAMINATION: RENAL TRANSPLANT U.S. PORT
INDICATION: ___ year old woman DDRT// eval renal transplant
TECHNIQUE: Grey scale as well as color and spectral Doppler ultrasound images
of the renal transplant were obtained.
COMPARISON: CTA abdomen pelvis dated ___.
FINDINGS:
The right iliac fossa transplant renal morphology is normal. Specifically,
the cortex is of normal thickness and echogenicity, pyramids are normal, there
is no urothelial thickening, and renal sinus fat is normal. There is no
hydronephrosis. There is a 5.0 x 1.6 x 1.5 cm perinephric fluid collection.
The resistive index of intrarenal arteries ranges from 0.55 to 0.66, within
the normal range. The may renal artery is patent with appropriate waveform.
Main renal artery shows peak systolic velocity of 62.7. Vascularity is
symmetric throughout transplant. The transplant renal vein is patent and shows
normal waveform.
IMPRESSION:
1. Patent transplant renal vasculature.
2. 5.0 x 1.6 x 1.5 cm perinephric minimally complex fluid collection,
compatible with a postsurgical collections such as an evolving hematoma or
seroma. No hydronephrosis.
|
19957410-RR-50 | 19,957,410 | 23,037,934 | RR | 50 | 2168-10-06 01:46:00 | 2168-10-06 11:31:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with etoh cirrhosis s/p kidney and liver
transplant// evaluate lung fields
TECHNIQUE: Semi-upright portable chest x-ray
COMPARISON: The chest x-ray ___
FINDINGS:
There has been interval removal of the endotracheal tube and nasogastric tube.
The remaining support lines are in stable positions. There is mild blunting
of left costophrenic angle. Right costophrenic angle is sharp. No
pneumothorax. There is worsening pulmonary edema. The left atelectasis is
mildly improved.
IMPRESSION:
1. Interval improvement left atelectasis. 2. Worsening pulmonary edema.
|
19957410-RR-51 | 19,957,410 | 23,037,934 | RR | 51 | 2168-10-05 12:40:00 | 2168-10-05 13:28:00 | EXAMINATION: CHEST PORT. LINE PLACEMENT
INDICATION: ___ year old woman with liver tx and kidney tx// new left IJ
placement Contact name: ___: ___
TECHNIQUE: Chest AP
COMPARISON: ___
IMPRESSION:
Lungs are well expanded with stable mediastinal shift to the left with
persistent complete atelectasis of the left lower lobe. Patient is slightly
rotated to the left. Pulmonary edema is unchanged. There is no pleural
effusion. No pneumothorax is seen.
|
19957410-RR-52 | 19,957,410 | 23,037,934 | RR | 52 | 2168-10-06 09:24:00 | 2168-10-06 12:15:00 | EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN)
INDICATION: ___ with decompensated HCV/EtOH cirrhosis c/b renal failure ___
presumed HRS on HD s/p DDLT and DDRT// Liver Duplex to assess patency of HA,
HV, PV s/p DDLT
TECHNIQUE: Grey scale, color and spectral Doppler ultrasound images of the
abdomen were obtained.
COMPARISON: None.
FINDINGS:
Liver echotexture is normal. Focal fat again demonstrated adjacent to the
falciform ligament, which is benign. There is no evidence of focal liver
lesions or biliary dilatation. The common hepatic duct measures 0.6 cm. There
is no ascites, right pleural effusion, or sub- or ___ fluid
collections/hematomas.
The spleen measures 11.6 cm and has normal echotexture.
DOPPLER: The main hepatic arterial waveform is within normal limits, with
prompt systolic upstrokes and continuous antegrade diastolic flow. Peak
systolic velocity in the main hepatic artery is 25.8 cm/sec. Appropriate
arterial waveforms are seen in the right hepatic artery and the left hepatic
artery with resistive indices of 0.75, and 0.69, respectively. The main
portal vein and the right and left portal veins are patent with hepatopetal
flow and normal waveform. Appropriate flow is seen in the hepatic veins and
the IVC.
IMPRESSION:
Patent hepatic vasculature with appropriate waveforms.
|
19957410-RR-53 | 19,957,410 | 23,037,934 | RR | 53 | 2168-10-07 04:38:00 | 2168-10-07 09:35:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ decompensated HCV/EtOH cirrhosis s/p liver and kidney txp.
Volume overload, now on Lasix drip.// interval change interval change
IMPRESSION:
Compared to chest radiographs ___ through ___.
Moderate pulmonary edema developed on ___, subsequently improved.
Pulmonary and mediastinal vasculature are still engorged and heart is
moderately enlarged. No clearly focal findings in the lungs to suggest
pneumonia.
Left jugular line ends in the upper right atrium, right jugular line in the
mid SVC and feeding tube passes into the stomach and out of view.
|
19957410-RR-54 | 19,957,410 | 23,037,934 | RR | 54 | 2168-10-07 05:00:00 | 2168-10-07 06:48:00 | EXAMINATION: DUPLEX DOPP ABD/PEL
INDICATION: ___ with decompensated HCV/EtOH cirrhosis c/b renal failure//
Liver Duplex to assess patency of HA, HV, PV s/p DDLT
TECHNIQUE: Grey scale, color and spectral Doppler ultrasound images of the
abdomen were obtained.
COMPARISON: Ultrasound from ___.
FINDINGS:
Liver echotexture is normal. There is no evidence of focal liver lesions or
biliary dilatation. The common hepatic duct measures 0.4 cm. There is no
ascites, right pleural effusion, or sub- or ___ fluid
collections/hematomas.
DOPPLER: The main hepatic arterial waveform is within normal limits, with
prompt systolic upstrokes and continuous antegrade diastolic flow. Peak
systolic velocity in the main hepatic artery is 84.1 cm/sec. Appropriate
arterial waveforms are seen in the right hepatic artery and the left hepatic
artery with resistive indices of 0.63, and 0.62, respectively. The main
portal vein and the right and left portal veins are patent with hepatopetal
flow and normal waveform. Appropriate flow is seen in the hepatic veins and
the IVC.
IMPRESSION:
Patent hepatic vasculature with appropriate waveforms.
|
19957410-RR-55 | 19,957,410 | 23,037,934 | RR | 55 | 2168-10-08 10:08:00 | 2168-10-08 11:55:00 | EXAMINATION: DUPLEX DOPP ABD/PEL
INDICATION: ___ year old woman s/p liver transplant with increasing LFTS//
evaluate hepatic vessels
TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were
obtained.
COMPARISON: Doppler ultrasound ___
FINDINGS:
LIVER: The transplant hepatic parenchyma appears within normal limits. The
contour of the liver is smooth. There is no focal liver mass. There is scant
trace ascites in the left lower quadrant. A tiny right pleural effusion is
also incidentally noted.
BILE DUCTS: There is no intrahepatic biliary dilation.
CHD: 5 mm
GALLBLADDER: The patient is status post cholecystectomy.
DOPPLER EXAMINATION: The main, right and left portal veins are patent with
hepatopetal flow. Arterial waveforms are seen in the hepatic arteries with
resistive indices of 0.61, 0.43 and 0.53 in the main, right and left hepatic
arteries respectively. Peak systolic flow in the main hepatic artery measures
75 cm/sec. The hepatic veins and IVC are patent.
IMPRESSION:
1. Patent transplant hepatic vasculature.
2. No biliary dilatation seen in the transplant liver.
3. Scant trace ascites in the left lower quadrant and tiny right pleural
effusion.
|
19957410-RR-56 | 19,957,410 | 23,037,934 | RR | 56 | 2168-10-10 01:05:00 | 2168-10-10 02:08:00 | EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: ___ with decompensated HCV/EtOH cirrhosis c/b renal failure ___
presumed HRS on HD s/p DDLT and DDRT now s/p unwitnessed mechanical fall and
headstrike// eval head trauma; multiple scalp hematomas
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast. Coronal and sagittal reformations as well as bone algorithm
reconstructions were provided and reviewed.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 4.0 s, 16.0 cm; CTDIvol = 46.7 mGy (Head) DLP =
747.7 mGy-cm.
Total DLP (Head) = 748 mGy-cm.
COMPARISON: None.
FINDINGS:
There is no evidence of acute infarction,hemorrhage,edema, or mass. Minimal
subcortical and periventricular white matter hypodensities are nonspecific,
likely sequelae of chronic small vessel ischemic disease. There is prominence
of the ventricles and sulci suggestive of involutional changes.
There is no evidence of fracture. Subgaleal hematomas are seen overlying the
posterior right parietal bone, the posterior left parietal bone, and the
occipital bone. Subcutaneous emphysema is noted within the left parietal soft
tissues (see 02:20). The visualized portion of the paranasal sinuses, mastoid
air cells, and middle ear cavities are clear. The visualized portion of the
orbits are preserved. Bilateral temporomandibular joint degenerative changes
are noted.
IMPRESSION:
1. No acute intracranial abnormality.
2. No evidence acute intracranial hemorrhage or fracture.
3. Bilateral posterior parietal and occipital subgaleal hematomas with left
parietal probable laceration.
|
19957410-RR-57 | 19,957,410 | 23,037,934 | RR | 57 | 2168-10-10 01:05:00 | 2168-10-10 02:16:00 | EXAMINATION: CT C-SPINE W/O CONTRAST
INDICATION: ___ with decompensated HCV/EtOH cirrhosis c/b renal failure ___
presumed HRS on HD s/p DDLT and DDRT s/p unwitnessed fall and headstrike//
eval c spine trauma
TECHNIQUE: Contiguous axial images obtained through the cervical spine
without intravenous contrast. Coronal and sagittal reformats were reviewed.
DOSE: Acquisition sequence:
1) Spiral Acquisition 4.0 s, 15.9 cm; CTDIvol = 25.1 mGy (Body) DLP = 399.4
mGy-cm.
Total DLP (Body) = 399 mGy-cm.
COMPARISON: None.
FINDINGS:
Dental amalgam streak artifact limits study.
There is reversal of the cervical lordosis. Calcification of the posterior
longitudinal ligament bridging C3 and C4 is noted. A linear lucency is seen
along the superior endplate C6, given surrounding sclerotic margins and lack
of prevertebral soft tissue swelling, this is likely degenerative in nature.
Vertebral body heights are preserved. There is no definite evidence of acute
fracture.
Multilevel degenerative changes are seen, most extensive at C4-5 and C5-6 and
notable for loss of intervertebral disc height, subchondral sclerosis,
Schmorl's node formation, facet arthrosis, uncovertebral hypertrophy, and
osteophytosis.There is no prevertebral edema.
The thyroid is preserved. Septal thickening is noted in the lung apices
suggestive of pulmonary edema. A nasogastric tube and bilateral central
catheters are partially visualized.
IMPRESSION:
1. Dental amalgam streak artifact limits study.
2. Within limits of study, no definite evidence of acute fracture.
3. Probable multilevel cervical spondylosis as described. Please note MRI of
the cervical spine is more sensitive for the evaluation of ligamentous injury.
4. Question pulmonary edema on limited imaging of lungs. Consider dedicated
chest imaging for further evaluation.
|
19957410-RR-58 | 19,957,410 | 23,037,934 | RR | 58 | 2168-10-11 16:01:00 | 2168-10-11 16:42:00 | EXAMINATION: UNILAT LOWER EXT VEINS RIGHT
INDICATION: ___ with decompensated HCV/EtOH cirrhosis c/b renal failure ___
presumed HRS on HD s/p DDLT and DDRT requiring pheresis now with right thigh
larger than left c/f DVT, assess for DVT
TECHNIQUE: Grey scale, color, and spectral Doppler evaluation was performed
on the right lower extremity veins.
COMPARISON: None.
FINDINGS:
There is normal compressibility and color flow of the right common femoral,
femoral, and popliteal veins. Normal color flow and compressibility are
demonstrated in the posterior tibial and peroneal veins.
There is normal respiratory variation in the bilateral common femoral veins.
No evidence of medial popliteal fossa (___) cyst. There is subcutaneous
edema in the right popliteal fossa and calf.
IMPRESSION:
No evidence of deep venous thrombosis in the right lower extremity veins.
|
19957410-RR-59 | 19,957,410 | 23,037,934 | RR | 59 | 2168-10-14 22:39:00 | 2168-10-14 23:40:00 | EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN)
INDICATION: ___ with decompensated HCV/EtOH cirrhosis c/b renal failure ___
presumed HRS on HD s/p DDLT and DDRT with elevated LFTs// Assess vasculature,
assess for ductal dilatation,assess for ___ collection
TECHNIQUE: Grey scale, color and spectral Doppler ultrasound images of the
abdomen were obtained.
COMPARISON: Ultrasound dated ___.
FINDINGS:
Liver echotexture is slightly echogenic and coarsened. There is no evidence of
focal liver lesions. There is new mild intrahepatic biliary ductal
dilatation. There is new dilatation of the common hepatic duct, which now
measures 0.8 cm, previously 0.5 cm. There is trace ascites. There is no
right pleural effusion, or sub- or ___ fluid collections/hematomas.
The spleen measures 15.7 cm and has normal echotexture.
DOPPLER: The main hepatic arterial waveform is within normal limits, with
prompt systolic upstrokes and continuous antegrade diastolic flow. Peak
systolic velocity in the main hepatic artery is 74.8 cm per second.
Appropriate arterial waveforms are seen in the right hepatic artery and the
left hepatic artery with resistive indices of 0.62, and 0.55, respectively.
The main portal vein and the right and left portal veins are patent with
hepatopetal flow and normal waveform. Appropriate flow is seen in the hepatic
veins and the IVC.
Bilateral kidneys demonstrate relatively echogenic cortices, most consistent
with medical renal disease.
IMPRESSION:
1. Patent hepatic vasculature with appropriate waveforms.
2. Interval increase in mild intrahepatic and extrahepatic biliary ductal
dilatation. The CBD now measures up to 8 mm, previously 5 mm.
3. Bilateral echogenic kidneys most consistent with medical renal disease.
4. Hepatic parenchyma is slightly echogenic and coarsened. Recommend
correlation with LFTs.
NOTIFICATION: The findings were discussed with Dr. ___ by ___
___, M.D. on the telephone on ___ at 11:37 pm, 2 minutes after
discovery of the findings.
|
19957410-RR-60 | 19,957,410 | 23,037,934 | RR | 60 | 2168-10-15 11:44:00 | 2168-10-15 16:30:00 | INDICATION: ___ year old woman with right upper quadrant pain 11 days post
liver transplant//
TECHNIQUE: Supine and left lateral decubitus images were obtained.
COMPARISON: ___
FINDINGS:
There are no abnormally dilated loops of large or small bowel. Skin staples
are noted in the right lower quadrant as well as the superior epigastric area.
A ___ jejunal feeding tube is noted. Surgical drain overlying the site of
liver transplant is noted. Clips in the upper midline area. There is a
surgical drain in the right lower quadrant and a stent at the area of the
renal transplant. No evidence of obstruction.
IMPRESSION:
Nonobstructive bowel gas pattern.
|
19957410-RR-61 | 19,957,410 | 23,037,934 | RR | 61 | 2168-10-16 09:25:00 | 2168-10-16 11:12:00 | EXAMINATION: MRCP
INDICATION: ___ with decompensated HCV/EtOH cirrhosis c/b renal failure ___
presumed HRS on HD s/p DDLT and DDRT. Now with rising alk phox, liver duplex
with CBD dilation to 8mm from 5mm, RUQ pain. Evaluate biliary stricture.// ?
biliary stricture
TECHNIQUE: T1- and T2-weighted multiplanar images of the abdomen were
acquired in a 1.5 T magnet.
Intravenous contrast: 8 mL Gadavist.
Oral contrast: 1 cc of Gadavist mixed with 50 cc of water was administered
for oral contrast.
COMPARISON: CT of the abdomen and pelvis dated ___.
FINDINGS:
Of note, study is moderately limited by patient motion.
Lower Thorax: There is no pleural or pericardial effusion.
Liver: Hepatic morphology and signal intensity are normal. Patient is status
post liver transplant. There is no evidence of suspicious lesion.
Biliary: There is moderate intrahepatic biliary ductal dilatation with an
abrupt transition point at the level of common bile duct anastomosis.
Proximal to the transition point the common bile duct measures up to 1.5 cm.
Distal to the transition point the common bile duct measures up to 1.4 cm.
Pancreas: Pancreas is normal in signal intensity and morphology without focal
lesion or ductal dilatation.
Spleen: There is moderate splenomegaly with the spleen measuring up to 17.9 cm
in greatest coronal dimension.
Adrenal Glands: Unremarkable.
Kidneys: The native kidneys are relatively T2 hyperintense without suspicious
focal lesion or hydronephrosis.
Gastrointestinal Tract: Visualized loops of large and small bowel. Enteric
tube is noted extending beyond the pylorus.
Lymph Nodes: No suspicious lymphadenopathy.
Vasculature: There are extensive perisplenic, esophageal, and gastric varices.
Due to significant motion degradation, evaluation of the hepatic arterial
anastomosis and portal venous anastomosis are substantially limited. The
portal venous anastomosis appears unremarkable on noncontrast imaging (2:18,
19), however it is not well evaluated on the postcontrast imaging and there
appears to be a mismatch in caliber between the donor and recipient main
portal veins.
Osseous and Soft Tissue Structures: There is no suspicious osseous lesion.
Multiple perineural cysts are noted. There is small volume ascites. There is
a severe edema in the right posterior body wall, likely related to recent
prior surgery. A surgical drainage catheter extends along the inferior margin
of the liver.
IMPRESSION:
1. Focal severe stricture at the biliary anastomosis with moderate upstream
intrahepatic and extrahepatic biliary ductal dilatation.
2. Evaluation of the portal venous and main hepatic arterial anastomoses are
substantially limited by motion degradation. If there is concern for vascular
anastomotic complication, multiphasic CT should be performed as it is less
susceptible to motion artifact.
3. Extensive varices. Small volume ascites. Moderate splenomegaly.
NOTIFICATION: The findings were discussed with ___, M.D. by ___
___, M.D. on the telephone on ___ at 11:11 am, 5 minutes after
discovery of the findings.
|
19957410-RR-62 | 19,957,410 | 23,037,934 | RR | 62 | 2168-10-17 10:37:00 | 2168-10-17 11:02:00 | EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ with decompensated HCV/EtOH cirrhosis c/b renal failure ___
presumed HRS on HD s/p DDLT and DDRT with subcostal pain// eval RUQ/subcostal
pain
IMPRESSION:
In comparison with the study of ___, the monitoring and support
devices are unchanged. The patient has taken a better inspiration and there
is no evidence of appreciable vascular congestion, pleural effusion, or acute
focal pneumonia.
|
19957410-RR-63 | 19,957,410 | 23,037,934 | RR | 63 | 2168-10-24 14:21:00 | 2168-10-24 16:50:00 | EXAMINATION: DUPLEX DOPP ABD/PEL
INDICATION: ___ female with decompensated HCV/EtOH cirrhosis c/b
renal failure ___ presumed HRS on HD s/p DDLT and DDRT with LFTs still
slightly elevated and standstill. Evaluation for hepatic vasculature, assess
for biliary dilitation and for perihepatic collection.
TECHNIQUE: Gray scale, color, and spectral Doppler evaluation of the abdomen
was performed.
COMPARISON: Comparison to prior ultrasound from ___. Comparison
to MRCP from ___.
FINDINGS:
Liver: The hepatic parenchyma is slightly echogenic and coarsened.
Pneumobilia is noted predominantly within the left intrahepatic lobe. No
focal liver lesions are identified. There is no ascites.
Bile ducts: There is no intrahepatic biliary ductal dilation. The common
hepatic duct measures 4 mm.
Gallbladder: The gallbladder is surgically absent.
Pancreas: The pancreas is obscured by overlying bowel gas.
Spleen: The spleen demonstrates normal echotexture, and measures 17.8 cm.
Kidneys: The partially visualized kidneys demonstrate echogenic cortices,
consistent with medical renal disease. No evidence of hydronephrosis.
Doppler evaluation:
The main portal vein is patent, with flow in the appropriate direction.
Main portal vein velocity is 15.6 cm/sec.
Right and left portal veins are patent, with antegrade flow.
The main hepatic artery is patent, with appropriate waveform.
Right, middle and left hepatic veins are patent, with appropriate waveforms.
IMPRESSION:
1. Patent hepatic vasculature.
2. Pneumobilia predominantly within the left hepatic lobe, however no evidence
of intrahepatic or extrahepatic biliary ductal dilatation.
3. Slightly echogenic and coarsened hepatic echotexture, similar in appearance
to prior studies.
4. Moderate splenomegaly measuring up to 17.8 cm.
5. Bilateral echogenic kidneys consistent with medical renal disease.
|
19957410-RR-64 | 19,957,410 | 23,037,934 | RR | 64 | 2168-10-24 15:27:00 | 2168-10-24 16:53:00 | EXAMINATION: CT abdomen pelvis
INDICATION: ___ with decompensated HCV/EtOH cirrhosis c/b renal failure ___
presumed HRS on HD s/p DDLT and DDRT with persistent RUQ burning pain. Please
use oral contrast only// PO contrast ONLY to evaluate for collection
TECHNIQUE: Multidetector CT images of the abdomen and pelvis were acquired
without intravenous contrast. Non-contrast scan has several limitations in
detecting vascular and parenchymal organ abnormalities, including tumor
detection.
Oral contrast was administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Found no primary dose record and no dose record stored with the sibling
of a split exam.
!If this Fluency report was activated before the completion of the dose
transmission, please reinsert the token called CT DLP Dose to load new data.
COMPARISON: MRCP ___
FINDINGS:
LOWER CHEST: Visualized lung fields are within normal limits. There is no
evidence of pleural or pericardial effusion.
ABDOMEN:
HEPATOBILIARY: Transplant liver appears unremarkable without evidence of focal
lesions within limitations of unenhanced scan. Mild, predominantly left-sided
pneumobilia is noted and presumably related to the CBD stent which appears
appropriately position. Distal aspect of the CBD stent is opacified with
debris, some of which is hyperdense suggesting possible hemorrhagic
components. Gallbladder is surgically absent.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions within the limitations of an unenhanced scan. There is no
pancreatic ductal dilatation. There is no peripancreatic stranding.
SPLEEN: Spleen is enlarged measuring up to 17.3 cm, but otherwise
unremarkable.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: The kidneys are of normal and symmetric size. There is no evidence
of focal renal lesions within the limitations of an unenhanced scan. There is
no hydronephrosis. There is no nephrolithiasis. There is no perinephric
abnormality. Unremarkable appearance of right lower quadrant transplant
kidney which contains a ureteral stent which appears appropriately position.
Adjacent nonhemorrhagic fluid collections in the region of the transplant
renal hilum and along the right pelvic sidewall measure 4.3 cm and 3.4 cm
respectively and may reflect postoperative lymphocele lower seromas.
GASTROINTESTINAL: The stomach is unremarkable. Small bowel loops demonstrate
normal caliber and wall thickness throughout. An enteric tube terminates in
the jejunum. The colon and rectum are within normal limits. Enteric contrast
extends the level of the sigmoid colon.
PELVIS: The urinary bladder and distal ureters are unremarkable. There is no
free fluid in the pelvis.
REPRODUCTIVE ORGANS: Status post hysterectomy.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease
is noted. Extensive paraesophageal and upper abdominal varices are noted.
BONES: There is no evidence of worrisome osseous lesions or acute fracture.
Mild scoliosis of the lumbar spine.
SOFT TISSUES: Postsurgical changes along the anterior abdominal wall are
noted. A right lower quadrant approach surgical drain terminates along the
right lower quadrant transplant kidney.
IMPRESSION:
1. Simple appearing fluid collections adjacent to the right lower quadrant
transplant kidney hilum and along the right pelvic sidewall measuring up to
4.3 cm likely reflect postoperative seromas or lymphoceles.
2. Debris is noted within the distal aspect of the CBD stent, though
pneumobilia and lack of intrahepatic biliary dilation suggest stent patency.
3. Splenomegaly, small volume abdominopelvic ascites, and extensive
paraesophageal and upper abdominal varices.
|
19957410-RR-65 | 19,957,410 | 23,037,934 | RR | 65 | 2168-10-28 15:34:00 | 2168-10-28 16:18:00 | EXAMINATION: CT CHEST W/O CONTRAST
INDICATION: ___ with decompensated HCV/EtOH cirrhosis c/b renal failure ___
presumed HRS on HD s/p DDLT and DDRT. Now with SIADH. Evaluate for pulmonary
nodules// SIADH; evaluate pulmonary nodules SIADH; evaluate pulmonary
nodules
TECHNIQUE: Volumetric CT acquisitions over the entire thorax in inspiration,
no administration of intravenous contrast material, multiplanar
reconstructions. Axial sagittal and coronal images were acquired.
DOSE: Acquisition sequence:
1) Spiral Acquisition 2.0 s, 32.2 cm; CTDIvol = 10.3 mGy (Body) DLP = 330.8
mGy-cm.
Total DLP (Body) = 331 mGy-cm.
COMPARISON:
No prior CT chest is available for comparison
FINDINGS:
THORACIC INLET: Thyroid is unremarkable. There are no enlarged
supraclavicular lymph nodes
BREAST AND AXILLA : There are no enlarged axillary lymph nodes
MEDIASTINUM: The NG tube projects below the left hemidiaphragm the tip
projects to the stomach. There is a moderate-sized hiatus hernia. The
ascending aorta is normal in size. The main pulmonary artery is mildly
enlarged and measures 3.8 cm. There is mild coronary artery calcification.
There is no pericardial effusion
PLEURA: There is no pleural effusion.
LUNG: There are no consolidations. There is a left lower lobe pulmonary
nodule measuring 7 mm (2, 28). There is minimal subsegmental atelectasis in
the right lung base..
BONES AND CHEST WALL : Review of bones is unremarkable.
UPPER ABDOMEN: Limited sections through the upper abdomen shows evidence of
pneumobilia. The spleen is mildly enlarged. Multiple collaterals are seen
along the azygos and hemi azygous with evidence of azygos continuation.
IMPRESSION:
Evidence of cirrhosis with for portal hypertension and pneumobilia.
7 mm left lower lobe pulmonary nodule. Three-month follow-up is recommended.
NG tube projects below the left hemidiaphragm.
Moderate-sized hiatus hernia.
|
19957410-RR-66 | 19,957,410 | 23,037,934 | RR | 66 | 2168-10-28 14:56:00 | 2168-10-28 16:34:00 | EXAMINATION: MR HEAD W/O CONTRAST T9113 MR HEAD
INDICATION: ___ female with decompensated HCV/EtOH cirrhosis c/b
renal failure ___ presumed HRS on HD s/p DDLT and DDRT. SIADH, evaluate for
intracranial etiology.
TECHNIQUE: Sagittal T1 weighted imaging was performed. Axial imaging was
performed with gradient echo, FLAIR, diffusion, and T2 technique were then
obtained.
COMPARISON CT head performed ___.
FINDINGS:
Examination is mildly degraded by motion. There is no evidence of hemorrhage,
edema, masses, mass effect, midline shift, or infarction.. The ventricles and
sulci are slightly prominent, likely secondary to involutional change.
Scattered periventricular and subcortical FLAIR signal hyperintensities are
nonspecific but may reflect the sequelae of chronic microvascular ischemic
disease. The major vascular flow voids appear preserved.
The visualized paranasal sinuses and mastoid air cells are clear. The orbits
are unremarkable.
IMPRESSION:
1. White matter hyperintensities suggesting chronic small vessel ischemia.
Otherwise normal brain MRI.
|
19957410-RR-70 | 19,957,410 | 24,629,182 | RR | 70 | 2168-11-20 16:21:00 | 2168-11-20 18:17:00 | EXAMINATION: DUPLEX DOPP ABD/PEL
INDICATION: S/p Liver Transplant 2 months prior, please assess for VESSEL
PATENCY (hep AA, portal VV)
TECHNIQUE: Gray scale, color, and spectral Doppler evaluation of the abdomen
was performed.
COMPARISON: Abdominal ultrasound from ___
FINDINGS:
Liver: The hepatic parenchyma is within normal limits. No focal liver
lesions are identified. There is no ascites.
Bile ducts: There is no intrahepatic biliary ductal dilation. Pneumobilia is
again seen. The common hepatic duct measures 2 mm.
Pancreas: The head, body and tail of the pancreas appear within normal
limits.
Spleen: The spleen demonstrates normal echotexture, and measures 13.4 cm.
Kidneys: Transplanted kidney evaluated in separate study performed
subsequently.
Doppler evaluation:
The main portal vein is patent, with flow in the appropriate direction.
Main portal vein velocity is 45 cm/sec.
Right and left portal veins are patent, with antegrade flow.
The main hepatic artery is patent, with appropriate waveform.
Right, middle and left hepatic veins are patent, with appropriate waveforms.
Splenic vein and superior mesenteric vein are patent, with antegrade flow.
IMPRESSION:
1. Patent hepatic vasculature.
2. Splenomegaly measuring 13.4 cm, improved since prior (17.8 cm).
|
19957410-RR-71 | 19,957,410 | 24,629,182 | RR | 71 | 2168-11-20 16:21:00 | 2168-11-20 18:20:00 | EXAMINATION: RENAL TRANSPLANT U.S.
INDICATION: ___ with above// s/p 2 month from renal transplant here w/
intractable nausea + vomiting, Transplant attending requesting US for vessel
patency
TECHNIQUE: Grey scale as well as color and spectral Doppler ultrasound images
of the renal transplant were obtained.
COMPARISON: Renal transplant ultrasound from ___
FINDINGS:
The right iliac fossa transplant renal morphology is normal. Specifically,
the cortex is of normal thickness and echogenicity, pyramids are normal, there
is no urothelial thickening, and renal sinus fat is normal. There is no
hydronephrosis and no perinephric fluid collection.
The resistive index of intrarenal arteries ranges from 0.64 to 0.73, within
the normal range. The main renal artery shows a normal waveform, with prompt
systolic upstroke and continuous antegrade diastolic flow, with peak systolic
velocity of 100-140 cm/s. Vascularity is symmetric throughout transplant. The
transplant renal vein is patent and shows normal waveform.
Small simple appearing fluid collection superior to the transplanted kidney
measures 1 x 1.4 x 0.9 cm, appears decreased in size since last ultrasound
previously measuring 1.5 x 1.5 x 4.9 cm, and likely represents a seroma.
IMPRESSION:
1. Normal renal transplant ultrasound.
2. Interval decrease in size of the small peritransplant collection thought to
represent a seroma.
|
19957410-RR-72 | 19,957,410 | 24,629,182 | RR | 72 | 2168-11-20 19:48:00 | 2168-11-20 20:22:00 | EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ with new headache w/ controlled nausea + vomiting x 24
hours// ICH?
TECHNIQUE: Routine unenhanced head CT was performed and viewed in brain,
intermediate and bone windows. Coronal and sagittal reformats were also
performed.
DOSE: Total DLP (Head) = 803 mGy-cm.
COMPARISON: Prior brain MRI from ___ and head CT from ___
FINDINGS:
There is no intra-axial or extra-axial hemorrhage, edema, shift of normally
midline structures, or evidence of acute major vascular territorial
infarction. Ventricles are normal in size. Sulcal prominence reflect age
related involutional changes. Relative cerebellar atrophy is noted. The
imaged paranasal sinuses are clear. Mastoid air cells and middle ear cavities
are well aerated. The bony calvarium is intact.
IMPRESSION:
No acute intracranial process.
|
19957410-RR-73 | 19,957,410 | 24,629,182 | RR | 73 | 2168-11-20 21:41:00 | 2168-11-20 23:13:00 | EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ with ams, immunocomprmised, abd pain. Evaluation for
pneumonia.
TECHNIQUE: Chest AP upright and lateral
COMPARISON: Comparison to multiple prior chest radiographs, most recently
from ___.
FINDINGS:
Interval removal of the enteric tube and right-sided central venous catheter.
Cardiomediastinal silhouette is stable. Mild calcification noted at the
aortic knob. The pulmonary vasculature is normal. Mild bibasilar
atelectasis. Lungs are otherwise clear without focal consolidation. No
pleural effusion or pneumothorax is seen.
IMPRESSION:
No acute intrathoracic process.
|
19957410-RR-74 | 19,957,410 | 24,629,182 | RR | 74 | 2168-11-20 21:41:00 | 2168-11-20 23:14:00 | INDICATION: History: ___ with ams, immunocomprmised, abd pain. Evaluation
for distended bowel loops.
TECHNIQUE: Supine and upright abdominal radiographs were obtained.
COMPARISON: Comparison to CT abdomen/pelvis from ___.
FINDINGS:
A paucity of bowel gas is noted, however there are no abnormally dilated loops
of large or small bowel.
Moderate fecal loading noted within the colon.
There is no free intraperitoneal air.
Osseous structures are unremarkable.
Multiple surgical clips again project over the right upper quadrant. The
common bile duct stent projects over the mid abdomen, slightly right of
midline.
IMPRESSION:
Nonspecific, nonobstructive bowel gas pattern with moderate fecal loading
noted within the colon.
|
19957410-RR-75 | 19,957,410 | 24,629,182 | RR | 75 | 2168-11-21 15:11:00 | 2168-11-21 17:09:00 | EXAMINATION: MR HEAD W AND W/O CONTRAST T9112 MR HEAD
INDICATION: ___ year old woman with history HCV/ EtOH cirrhosis s/p deceased
donor liver and renal transplant on ___, here with
nausea/vomiting/headache, this morning with altered mental status and
difficult to arouse// intracranial pathology? any infarct?
TECHNIQUE: Sagittal and axial T1 weighted imaging were performed. After
administration of intravenous contrast, axial imaging was performed with
gradient echo, FLAIR, diffusion, and T1 technique. Sagittal MPRAGE imaging was
performed and re-formatted in axial and coronal orientations.
COMPARISON: CT head without contrast dated ___
MR head dated ___
FINDINGS:
No evidence of acute territorial infarction, hemorrhage, masses or midline
shift. Ventricles and sulci are slightly prominent, likely due to
involutional changes. Intrinsic T1 hyperintensity within the bilateral basal
ganglia is likely secondary to mineralization. Periventricular and
subcortical white matter T2/FLAIR hyperintensities are nonspecific but likely
sequelae of chronic small vessel ischemic disease. The major flow voids are
preserved. Mild maxillary sinus disease.
IMPRESSION:
1. No acute infarction or hemorrhage.
2. Evidence of chronic ischemic vessel disease.
|
19957410-RR-76 | 19,957,410 | 24,629,182 | RR | 76 | 2168-11-22 07:53:00 | 2168-11-22 09:57:00 | EXAMINATION: NON TARGETED LIVER BIOPSY WITH ULTRASOUND GUIDANCE.
INDICATION: ___ year old woman s/p deceased donor liver transplant one month
ago with elevated liver enzymes// ****please biopsy liver transplant by 10 am
to get RUSH processing
COMPARISON: CT from ___.
PROCEDURE: Ultrasound-guided non-targeted transplant liver biopsy.
OPERATORS: Dr. ___, radiology trainee and Dr. ___,
attending radiologist. Dr. ___ personally supervised the trainee
during the key components of the procedure and reviewed and agrees with the
trainee's findings.
FINDINGS:
Limited preprocedure grayscale and Doppler ultrasound imaging of the right
hepatic lobe was performed and a suitable approach for non targeted liver
biopsy was determined. No other abnormalities were identified on the limited
imaging.
TECHNIQUE: The risks, benefits, and alternatives of the procedure were
explained to the patient. After a detailed discussion, informed written
consent was obtained. A pre-procedure timeout using three patient identifiers
was performed per ___ protocol.
Based on the preprocedure imaging, an appropriate skin entry site for the
biopsy was chosen. The site was marked. The skin was then prepped and draped
in the usual sterile fashion. The superficial soft tissues to the liver
capsule were anesthetized with 8 mL 1% lidocaine. Under real-time ultrasound
guidance, an 18 gauge core biopsy needle was then advanced into the right lobe
of the liver and a single core biopsy sample was obtained and placed in
formalin, and was sent directly to the pathology lab for rush technique. The
skin was then cleaned and a dry sterile dressing was applied. There was no
immediate complications.
SEDATION: Moderate sedation was provided by administering divided doses of 2
mg Versed and 100 mcg fentanyl throughout the total intra-service time of 24
minutes during which patient's hemodynamic parameters were continuously
monitored by an independent trained radiology nurse.
IMPRESSION:
Uncomplicated non-targeted transplant liver biopsy.
|
19957410-RR-93 | 19,957,410 | 26,712,985 | RR | 93 | 2169-01-23 17:24:00 | 2169-01-23 17:47:00 | EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: ___ year old woman w hx alcoholic cirrhosis with HRS now s/p
liver-kidney transplant (___) complicated by moderate liver rejection
(liver bx ___ s/p 5-day course ofIV ATG (___), and
anastomotic stricture requiring CBDstent placement (___) which was found
to be inferiorly displaced, requiring subsequent repeat biliary stent (2
stents) placement (___), as well as h/o SIADH, migraines,
depression/anxiety// Evaluate for any overt lesions given recurrent headaches.
Recently found to have new hepatic abscesses s/p 5 days of IV ATG
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 10.0 s, 17.0 cm; CTDIvol = 48.5 mGy (Head) DLP =
824.4 mGy-cm.
2) Sequenced Acquisition 10.0 s, 17.0 cm; CTDIvol = 48.5 mGy (Head) DLP =
824.4 mGy-cm.
Total DLP (Head) = 1,675 mGy-cm.
COMPARISON: Noncontrast head CTs including ___
and brain MRIs including ___ and ___
FINDINGS:
There is no evidence of infarction, hemorrhage, edema, or mass. Mild
periventricular and subcortical white matter hypodensities are nonspecific but
likely sequelae of chronic small vessel ischemic disease, better characterized
on prior MRI. There is prominence of the ventricles and sulci suggestive of
involutional changes.
There is no evidence of fracture. The visualized portion of the paranasal
sinuses, mastoid air cells, and middle ear cavities are clear. The visualized
portion of the orbits are unremarkable.
IMPRESSION:
No evidence of an acute intracranial abnormality.
|
19957410-RR-94 | 19,957,410 | 26,712,985 | RR | 94 | 2169-01-24 16:40:00 | 2169-01-24 17:30:00 | EXAMINATION: DX CHEST PORT LINE/TUBE PLCMT 1 EXAM
INDICATION: ___ year old woman with 44cm right arm SL power PICC. ___
___// 44cm right PICC Contact name: ___: ___
TECHNIQUE: Chest PA and lateral
COMPARISON: A ___
IMPRESSION:
Left-sided PICC line has been removed. Right-sided PICC line has been placed
with its tip in the cavoatrial junction. There is moderate cardiomegaly.
There is mild interstitial edema. There is no pleural effusion. No
pneumothorax.
|
19957410-RR-99 | 19,957,410 | 23,304,523 | RR | 99 | 2169-03-04 00:24:00 | 2169-03-04 03:31:00 | EXAMINATION: CT ABD AND PELVIS W/O CONTRAST
INDICATION: +PO contrast; History: ___ with abd pain, tenderness+PO
contrast// ?infectious/acute process
TECHNIQUE: Multidetector CT images of the abdomen and pelvis were acquired
without intravenous contrast. Non-contrast scan has several limitations in
detecting vascular and parenchymal organ abnormalities, including tumor
detection.
Oral contrast was not administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Spiral Acquisition 5.9 s, 46.6 cm; CTDIvol = 20.3 mGy (Body) DLP = 946.4
mGy-cm.
Total DLP (Body) = 946 mGy-cm.
COMPARISON: CT abdomen and pelvis ___
FINDINGS:
LOWER CHEST: There is mild bibasilar atelectasis. There is no evidence of
pleural or pericardial effusion.
ABDOMEN:
HEPATOBILIARY: The transplant liver demonstrates subtle wedge-shaped
hypoattenuation in the right hepatic lobe (02:20). There is no evidence of
focal lesions within the limitations of an unenhanced scan. Re-demonstrated
is mild pneumobilia likely secondary to biliary stent placement. There is no
intrahepatic biliary ductal dilation. Cholecystectomy clips are noted. The
gallbladder is within normal limits.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions within the limitations of an unenhanced scan. There is no
pancreatic ductal dilatation. There is no peripancreatic stranding.
SPLEEN: The spleen is enlarged measuring 17.1 cm
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: The native kidneys are atrophic. The transplant kidney in the right
lower quadrant appears unremarkable within the limits of a noncontrast study.
There is no evidence of focal renal lesions within the limitations of an
unenhanced scan. There is no hydronephrosis. There is no nephrolithiasis.
There is no perinephric abnormality.
GASTROINTESTINAL: There is a small hiatal hernia. Small bowel loops
demonstrate normal caliber and wall thickness throughout. The colon and
rectum are within normal limits. The appendix is normal.
PELVIS: The urinary bladder and distal ureters are unremarkable. There is no
free fluid in the pelvis.
REPRODUCTIVE ORGANS: The visualized reproductive organs are unremarkable.
LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There
is no pelvic or inguinal lymphadenopathy.
VASCULAR: Extensive varices are again noted. There is no abdominal aortic
aneurysm. Mild atherosclerotic disease is noted.
BONES: Chronic left-sided rib fractures are noted. There is no evidence of
worrisome osseous lesions or acute fracture.
SOFT TISSUES: The abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. There is subtle peripheral wedge-shaped hypoattenuation areas in the right
hepatic lobe. Findings may represent transplant rejection. Correlation with
liver function tests recommended.
2. Mild pneumobilia compatible with biliary stenting.
3. Moderate splenomegaly.
4. Small hiatal hernia.
|
19957626-RR-95 | 19,957,626 | 29,473,900 | RR | 95 | 2203-02-28 16:50:00 | 2203-02-28 17:03:00 | EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ F with chest pain radiating to the back
TECHNIQUE: Chest PA and lateral
COMPARISON: ___ fall chest radiograph and ___ chest CT
FINDINGS:
Heart size is normal. Mediastinal and hilar contours are normal. Lungs are
clear. Pulmonary vasculature is normal. No pleural effusion or pneumothorax
is present. Cervical spinal fusion hardware is incompletely assessed. A
gastric band is noted within the left upper quadrant of the abdomen as well as
clips in the right upper quadrant of the abdomen.
IMPRESSION:
No acute cardiopulmonary abnormality.
|
19957626-RR-96 | 19,957,626 | 29,473,900 | RR | 96 | 2203-02-28 20:17:00 | 2203-02-28 22:00:00 | EXAMINATION: Abdominal/pelvic CT.
INDICATION: ___ with abdominal pain 1 month after lap cholecystectomy.
TECHNIQUE: MDCT axial images were acquired through the abdomen and pelvis
following intravenous contrast administration with split bolus technique.
Coronal and sagittal reformations were performed and reviewed on PACS. Oral
contrast was administered.
DOSE: This study involved 4 CT acquisition phases with dose indices as
follows:
1) CT Localizer Radiograph
2) CT Localizer Radiograph
3) Stationary Acquisition 5.5 s, 0.5 cm; CTDIvol = 26.5 mGy (Body) DLP =
13.2 mGy-cm.
4) Spiral Acquisition 4.7 s, 51.5 cm; CTDIvol = 15.1 mGy (Body) DLP = 778.3
mGy-cm.
Total DLP (Body) = 792 mGy-cm.
COMPARISON: Prior abdominal/pelvic CT from ___.
FINDINGS:
LOWER CHEST: There is mild bibasilar atelectasis. There is no pleural
effusion. Visualized portions of the heart are within normal limits.
ABDOMEN:
HEPATOBILIARY: The liver morphology is normal. There is a geographic
hypodensity adjacent to the falciform ligament, which likely reflects an area
of focal fatty sparing, (series 2, image 17). The liver otherwise demonstrate
homogenous attenuation throughout. There is no evidence of concerning focal
lesions. There is no evidence of intrahepatic biliary dilatation. The
gallbladder is surgically absent with clips noted in the gallbladder fossa.
There is no evidence of biloma or fluid collections. The common bile duct
measures up to 7 mm, which is top normal in size for the patient's age.
PANCREAS: The pancreas has normal attenuation throughout, without evidence of
focal lesions or pancreatic ductal dilatation. There is no peripancreatic
stranding.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesions.
ADRENALS: The right and left adrenal glands are normal in size and shape.
URINARY: The kidneys are of normal and symmetric size with normal nephrogram.
Small bilateral cortical and peripelvic hypodensities likely reflect cysts.
There is no evidence concerning focal renal mass or hydronephrosis. There is
no perinephric abnormality.
GASTROINTESTINAL: A gastric band is seen in unchanged position. The stomach
appears unremarkable. Small bowel loops demonstrate normal caliber, wall
thickness and enhancement throughout. Colonic diverticulosis is present
without diverticulitis. There is moderate fecal loading seen throughout the
large bowel. Colon and rectum are otherwise within normal limits. Appendix is
normal. There is no evidence of mesenteric lymphadenopathy. No free air or
free fluid is demonstrated.
RETROPERITONEUM: There is no evidence of retroperitoneal lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. There is no calcium burden in
the abdominal aorta and great abdominal arteries.
PELVIS: The urinary bladder and distal ureters are unremarkable. There is no
evidence of pelvic or inguinal lymphadenopathy. There is no free fluid in the
pelvis.
REPRODUCTIVE ORGANS: Uterus likely contains at least one small partially
exophytic fibroid posteriorly (2:72). Adnexae are unremarkable.
BONES AND SOFT TISSUES: There is no evidence of worrisome osseous lesions.
There is no fracture. Abdominal and pelvic wall is within normal limits.
Patient is status post lumbar fusion spanning L4 through S1 levels. Moderate
degenerative changes are noted at the thoracolumbar spine with grade 1 L1 on
L2 retrolisthesis. Bone islands are seen in the right sacrum and left iliac
wing.
IMPRESSION:
Status post cholecystectomy with no evidence of acute intra-abdominal
findings. Specifically, no evidence of fluid collections within the
gallbladder fossa or biloma.
NOTIFICATION: The findings were discussed by Dr. ___ with Dr.
___ on the telephone on ___ at 9:58 ___, 5 minutes after discovery of
the findings.
|
19957626-RR-97 | 19,957,626 | 29,473,900 | RR | 97 | 2203-03-01 09:17:00 | 2203-03-01 14:35:00 | EXAMINATION: Double contrast upper GI series
INDICATION: ___ year old woman with epigastric pain s/p lap chole // patient
with gastric/small bowel defect vs obstruction
TECHNIQUE: Double contrast upper GI series
DOSE: Acc air kerma: 23 mGy; Accum DAP: 306.5 uGym2; Fluoro time: 3 min 3
seconds
COMPARISON: CT abdomen dated ___.
FINDINGS:
ESOPHAGUS:
The esophagus was not dilated. There was no esophageal web, ring, or
stricture. There was no esophageal mass. The esophageal mucosa appears within
normal limits.
The primary peristaltic wave was normal, with contrast passing readily into
the stomach. The lower esophageal sphincter opened and closed normally.
There was no gastroesophageal reflux. There was no hiatal hernia.
STOMACH:
The gastric lap band appears to be in appropriate position. Views of the
stomach show appropriate distention. No focal lesion is identified. No
evidence of gastric outlet obstruction, and barium passes freely into the
duodenum.
IMPRESSION:
Gastric lap band in appropriate position. Normal double contrast upper GI
series.
|
19957675-RR-16 | 19,957,675 | 25,518,836 | RR | 16 | 2123-10-06 01:42:00 | 2123-10-06 02:46:00 | EXAMINATION: UNILAT UP EXT VEINS US LEFT
INDICATION: ___ with swelling post chemo. R/o dvt, abscess.
TECHNIQUE: Grey scale and Doppler evaluation was performed on the left upper
extremity veins.
COMPARISON: None available.
FINDINGS:
There is normal flow with respiratory variation in the bilateral subclavian
veins.
The left internal jugular and axillary veins are patent and compressible with
transducer pressure.
The left brachial and basilic veins are patent, compressible with transducer
pressure and show normal color flow and augmentation.
There is occlusive thrombus in the cephalic vein at the level of the left
wrist, extending proximally to the level of the elbow. The cephalic vein
itself is not visualized more proximally in the upper arm.
IMPRESSION:
1. Occlusive thrombus in the left cephalic vein from the level of the wrist,
extending proximally to the level of the elbow. The cephalic vein was not
identified proximally in the upper arm.
2. No evidence of deep venous thrombosis in the left internal jugular, left
brachial, and left basilic veins.
|
19957730-RR-30 | 19,957,730 | 23,135,742 | RR | 30 | 2135-10-01 21:10:00 | 2135-10-01 22:06:00 | INDICATION: ___ woman with shortness of breath on exertion and
history of CHF.
COMPARISON: Chest radiograph ___.
PA AND LATERAL CHEST RADIOGRAPHS: The cardiomediastinal and hilar contours
are stable, with mild cardiomegaly. Again seen are moderate-sized pleural
effusions bilaterally, with associated bibasilar atelectasis, unchanged since
the prior study. No evidence of pulmonary edema. No pneumothorax is
detected. A left-sided AICD device is seen with the leads in the expected
position of the right atrium and right ventricle.
IMPRESSION: Moderate bibasilar effusions, not significantly changed since the
earlier study of ___.
|
19957730-RR-31 | 19,957,730 | 23,135,742 | RR | 31 | 2135-10-02 10:13:00 | 2135-10-02 10:58:00 | RENAL ULTRASOUND
DATE: ___.
CORRELATION: Chest radiograph ___.
CLINICAL INDICATION: ___ woman with acute-on-chronic kidney injury.
Evaluate for hydronephrosis and kidney size.
TECHNIQUE: Multiple sonographic gray-scale images of the kidneys and bladder
were obtained. Select images were supplemented with color Doppler imaging.
FINDINGS:
The right kidney measures approximately 8.8 cm. The left kidney measures
approximately 8.9 cm. Cortical echogenicity appears mildly echogenic. There
is no hydronephrosis or nephrolithiasis. There are bilateral simple renal
cysts. In the superior pole of the right kidney, a 2-cm simple cyst is
present, predominantly exophytic. In the interpolar region of the left
kidney, there is an 8-mm exophytic simple cyst. The bladder is incompletely
distended but grossly unremarkable.
Incidental note is made of bilateral right greater than left pleural
effusions, seen on recent chest x-ray.
IMPRESSION:
1. Symmetric-sized kidneys measuring less than 9 cm with mildly echogenic
cortices, which may indicate medical renal disease. No hydronephrosis.
2. Bilateral simple renal cysts.
3. Bilateral, right greater than left pleural effusions.
|
19957730-RR-32 | 19,957,730 | 26,550,638 | RR | 32 | 2135-10-09 14:44:00 | 2135-10-09 15:25:00 | INDICATION: ___ female with dyspnea and CHF. Question fluid overload
or infiltrate.
COMPARISON: Chest radiograph on ___.
FINDINGS: PA and lateral views of the chest. Left-sided AICD device is seen
with leads in the expected position of the right atrium and right ventricle.
There are bibasilar effusions, left greater than right, both of which have
slightly increased in size compared to prior study. There is bibasilar
atelectasis. The upper lung zones are clear. The cardiac, mediastinal and
hilar contours are stable.
IMPRESSION: Slight increase in bibasilar effusions, left greater than right,
compared to study on ___.
|
19957847-RR-13 | 19,957,847 | 25,782,996 | RR | 13 | 2146-03-31 18:52:00 | 2146-03-31 22:55:00 | EXAMINATION: Chest radiograph.
INDICATION: ___ with intubated, sedated. Assess endotracheal tube position.
TECHNIQUE: Single portable frontal chest radiograph.
COMPARISON: Chest radiograph ___.
FINDINGS:
The lungs are hypoinflated with crowding of vasculature. The lungs are
otherwise clear. Small left pleural effusion is again noted. No right
pleural effusion. No pneumothorax. Heart size, mediastinal contour, and hila
are unremarkable.
An endotracheal tube is in appropriate position 4.5 cm above the level of the
carina. An enteric feeding tube is seen coursing midline with tip in stomach.
Limited assessment of the osseous structures are notable for subtle cortical
step-off along the lateral fifth right rib worrisome for a minimally displaced
rib fracture.
IMPRESSION:
1. Unchanged small left pleural effusion.
2. Endotracheal tube in appropriate position.
3. Findings worrisome for lateral fifth right rib fracture, unchanged in
appearance since prior examination.
|
19957847-RR-14 | 19,957,847 | 25,782,996 | RR | 14 | 2146-04-01 04:23:00 | 2146-04-01 10:58:00 | EXAMINATION: MR HEAD W AND W/O CONTRAST T___ MR HEAD
INDICATION: ___ year old man with hx TBI and seizure p/w status epilepticus
// ?stroke vs seizure focus
TECHNIQUE: Sagittal T1 weighted imaging was performed. Axial imaging was
performed with gradient echo, FLAIR, diffusion, and T2 technique were then
obtained.
COMPARISON None.
FINDINGS:
There is no diffuse signal abnormality to suggest acute infarction. Multiple
small scattered foci of increased susceptibility artifact on gradient echo
images in the cerebrum, cerebellum, right thalamus, and pons are consistent
with micro hemorrhages. Confluent periventricular subcortical white matter
T2/FLAIR hyperintensities are nonspecific but likely sequelae of chronic
microangiopathy. There is no evidence of acute hemorrhage, edema, masses, or
mass effect. There is prominence of the ventricles and sulci suggestive
involutional changes, advanced for age. The intracranial vascular flow voids
are preserved. Mucosal thickening and mucous retention cysts are present in
the maxillary sinuses bilaterally. In the right posterior ethmoid air cells
are opacified and there is fluid in the nasopharynx. Distal right vertebral
artery demonstrates diminished flow void (9:4) which may be due to
atherosclerotic disease.
IMPRESSION:
1. No evidence of acute hemorrhage or infarction. No mass or mass effect.
2. Scattered foci of increased susceptibility artifact on gradient echo
images in the cerebrum, cerebellum, right thalamus, and pons are consistent
with micro hemorrhages likely from hypertension.
3. Moderate white matter microvascular ischemic change including scattered
chronic lacunar infarcts in the basal ganglia and thalami.
4. Global atrophy is advanced for age.
|
19957847-RR-15 | 19,957,847 | 25,782,996 | RR | 15 | 2146-04-01 04:44:00 | 2146-04-01 11:00:00 | EXAMINATION:
MRI OF THE CERVICAL SPINE
INDICATION: ___ year old man with ___ man with PMH of seizure disorder with
self stopped unknown AED and heavy alcohol use, TBI and dementia who presents
for status epilepticus. // r/o ligamentous injury
TECHNIQUE: T1, T2 and inversion recovery sagittal and gradient sequence T2
axial images of cervical spine obtained.
COMPARISON: None.
FINDINGS:
There is no evidence of bony or ligamentous injury in the cervical region. No
signs of ligamentous disruption. At the craniocervical junction no
significant abnormalities are seen.
At C2-3, C3-4 and C4-5 mild degenerative changes seen without spinal stenosis
or foraminal narrowing.
At C5-6 and C6-7 mild disc bulging identified with mild narrowing of the
foramina at C5-6 and mild narrowing of the left foramen at C6-7.
From C7-T1 to T3-4 minimal degenerative change seen.
The spinal cord shows normal intrinsic signal without extrinsic compression.
IMPRESSION:
No evidence of ligamentous or bony injury. Mild degenerative changes without
high-grade spinal stenosis or foraminal narrowing.
|
19957847-RR-16 | 19,957,847 | 25,782,996 | RR | 16 | 2146-04-01 02:44:00 | 2146-04-01 08:37:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with ___ man with PMH of seizure disorder with
self stopped unknown AED and heavy alcohol use, TBI and dementia who presents
for status epilepticus. // interval change- given fever 105 and possible
aspiration at time of seizure interval change- given fever 105 and possible
aspiration at time of seizure
IMPRESSION:
Comparison to ___. No relevant change is noted. Low lung volumes.
Stable monitoring and support devices. Mild cardiomegaly with mild fluid
overload but no overt pulmonary edema. Mild atelectasis at the left lung
basis is stable.
|
19957847-RR-17 | 19,957,847 | 25,782,996 | RR | 17 | 2146-04-01 02:45:00 | 2146-04-01 10:32:00 | INDICATION: ___ year old man with ___ man with PMH of seizure disorder with
self stopped unknown AED and heavy alcohol use, TBI and dementia who presents
for status epilepticus. // radiographic clearance for MRI
TECHNIQUE: Three views frontal hole supine abdominal radiographs.
COMPARISON: Portable chest X-ray dated ___.
FINDINGS:
There is an enteric tube with tip and side-port in the stomach.
There is a foreign body projecting the right upper quadrant, which appears to
be a syringe, likely external to the patient. There are no other radiopaque
foreign bodies seen.
There are no abnormally dilated loops of large or small bowel.
Supine assessment limits detection for free air; there is no gross
pneumoperitoneum.
Osseous structures are unremarkable.
There are no unexplained soft tissue calcifications.
IMPRESSION:
1. Foreign body projecting over the right upper quadrant, which appears to be
a syringe, likely external to the patient, otherwise no other radiopaque
foreign bodies are seen as contraindication to MRI.
2. Nonobstructive bowel gas pattern.
|
19957847-RR-18 | 19,957,847 | 25,782,996 | RR | 18 | 2146-04-01 02:46:00 | 2146-04-01 08:42:00 | EXAMINATION: ELBOW, AP AND LAT VIEWS RIGHT
INDICATION: ___ year old man with ___ man with PMH of seizure disorder with
self stopped unknown AED and heavy alcohol use, TBI and dementia who presents
for status epilepticus. // ? fractures right arm
TECHNIQUE: Two views of right elbow.
COMPARISON: None available
FINDINGS:
Olecranon plate and screw fixation is present. No residual fracture line is
seen. No evidence of elbow joint effusion. No acute fracture is seen. There
is a small medial epicondylar spur. There is mild proximal radioulnar
degenerative change. There is also mild degenerative change at the ulnar
trochlear joint. Curvilinear densities projecting over the soft tissues of
the distal upper arm and proximal forearm are presumed extrinsic to the
patient, but recommend clinical correlation.
IMPRESSION:
Postoperative and mild degenerative changes. No acute fracture is seen.
Curvilinear densities projecting over the distal upper arm and proximal
forearm, may be outside the patient or recommend clinical correlation.
|
19957847-RR-19 | 19,957,847 | 25,782,996 | RR | 19 | 2146-04-01 03:23:00 | 2146-04-01 08:39:00 | EXAMINATION: ELBOW (AP, LAT AND OBLIQUE) LEFT
INDICATION: ___ year old man with ___ man with PMH of seizure disorder with
self stopped unknown AED and heavy alcohol use, TBI and dementia who presents
for status epilepticus. // pe radiology reccs
TECHNIQUE: Two views of the left elbow.
COMPARISON: None available
FINDINGS:
Non standard projections limited evaluation. Small density projecting over
the central portion of the elbow joint may reflect a small intra-articular
body. No discrete fracture line is seen. IV cannula is demonstrated. Some
apparent vascular calcifications also noted in the forearm.
IMPRESSION:
No definite fracture, if symptoms persist suggest repeat radiographs given
nonstandard current projection.
|
19957847-RR-20 | 19,957,847 | 25,782,996 | RR | 20 | 2146-04-01 08:46:00 | 2146-04-02 12:28:00 | INDICATION: ___ year old man with status epilepticus s/p fall // eval
CT-spine for injury
TECHNIQUE: Outside hospital CT images of the head and C-spine. This is a
second read request for the patient.
COMPARISON: None.
FINDINGS:
CT of the head: There is no evidence of acute intracranial hemorrhage or mass
effect. Evidence of chronic infarction is seen in the left frontal lobe.
Periventricular hypodensities are likely secondary to chronic small vessel
ischemic disease. Mildly prominent ventricles and sulci are advanced for age.
The basilar cisterns are patent.
No acute fracture is identified. The visualized paranasal sinuses demonstrate
moderate mucosal sinus disease. The mastoid air cells, and middle ear
cavities are clear. The globes are unremarkable.
CT of the C-spine: Mild multilevel degenerative changes of the cervical spine
are identified. There is no prevertebral soft tissue swelling or traumatic
fracture. A small amount of fluid is seen layering within the pharynx.
Dense calcifications are seen within the bilateral internal carotid arteries.
There is no cervical lymphadenopathy. The visualized apices of the lungs are
clear.
IMPRESSION:
1. Likely chronic infarction of the left frontal lobe. No acute intracranial
hemorrhage. Chronic microangiopathy.
2. No acute cervical spine fractures identified. Mild degenerative changes
of the cervical spine.
|
19957847-RR-21 | 19,957,847 | 25,782,996 | RR | 21 | 2146-04-02 06:07:00 | 2146-04-02 13:06:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with status epilepticus s/p intubation // eval
for interval change eval for interval change
IMPRESSION:
Compared to chest radiographs ___ and ___.
Left lower lobe consolidation is new, could be atelectasis or major aspiration
leading to early pneumonia. No appreciable pleural effusion. Heart is normal
size though larger today than before. No pleural abnormality.
Tip of the endotracheal tube is in standard position. Right PIC line ends in
the low SVC. Esophageal drainage tube ends in the distal portion of
nondistended stomach.
|
19957847-RR-22 | 19,957,847 | 25,782,996 | RR | 22 | 2146-04-01 13:52:00 | 2146-04-01 15:22:00 | EXAMINATION: DX CHEST PORTABLE PICC LINE PLACEMENT
INDICATION: ___ year old man with new R PICC // 41cm R brachial DL PICC -
___ ___ Contact name: ___: ___
TECHNIQUE: Single frontal view of the chest
COMPARISON: Study performed the same day earlier in the morning
IMPRESSION:
Right PICC tip is in thelower SVC. No other interval changes. .
|
19957847-RR-23 | 19,957,847 | 25,782,996 | RR | 23 | 2146-04-04 05:11:00 | 2146-04-04 07:39:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with seizures, respiratory failure, intubated //
Interval changes Interval changes
IMPRESSION:
COMPARED TO CHEST RADIOGRAPHS ___ THROUGH ___.
Mild pulmonary edema persists, redistributed toward the lung bases, with
increasing atelectasis and, on a alternatively aspiration pneumonia. Careful
followup advised. . Mild cardiomegaly. Mediastinal venous engorgement.
ET tube and transesophageal drainage tube in standard placements. Right PIC
line ends in the upper right atrium.
|
19957847-RR-24 | 19,957,847 | 25,782,996 | RR | 24 | 2146-04-05 04:25:00 | 2146-04-05 09:24:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with status epilepticus s/p extubation with O2
requirement. // ?PNA vs pulmonary congestion. ?PNA vs pulmonary
congestion.
IMPRESSION:
Comparison to ___. The patient has been extubated and the
nasogastric tube was removed. The right PICC line is in stable position.
Improved ventilation of the lung bases, both on the left and on the right, are
reflected by higher lung volumes. Decrease in extent of the pre-existing
areas of atelectasis. Borderline size of the cardiac silhouette persists. No
pulmonary edema.
|
19957862-RR-39 | 19,957,862 | 23,350,408 | RR | 39 | 2208-11-12 00:02:00 | 2208-11-12 03:06:00 | EXAMINATION: CHEST (PA AND LAT)
INDICATION: History: ___ with abd pn, cough. Evaluation for lower lobe PNA
TECHNIQUE: Chest PA and lateral
COMPARISON: Comparison to radiograph from ___
FINDINGS:
Cardiomediastinal silhouette is within normal limits. The pulmonary
vasculature is normal. Mild opacification at the left lower lung is likely
compatible with atelectasis, however infection cannot be excluded in the
appropriate clinical setting. Lungs are otherwise clear. No pleural effusion
or pneumothorax is seen.
IMPRESSION:
Minimal ground-glass opacification at the left lower lung base is likely
compatible with atelectasis, however infection cannot be excluded in the
appropriate clinical setting.
|
19957862-RR-40 | 19,957,862 | 23,350,408 | RR | 40 | 2208-11-12 00:25:00 | 2208-11-12 02:32:00 | EXAMINATION: CT ABDOMEN AND PELVIS WITH CONTRAST
INDICATION: History: ___ with bilat Lower quad abd pn, N/V, diarrhea.
Evaluation for diverticulitis.
TECHNIQUE: Single phase split bolus contrast: MDCT axial images were acquired
through the abdomen and pelvis following intravenous contrast administration
with split bolus technique.
Oral contrast was not administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Stationary Acquisition 0.5 s, 0.5 cm; CTDIvol = 2.4 mGy (Body) DLP = 1.2
mGy-cm.
2) Stationary Acquisition 2.0 s, 0.5 cm; CTDIvol = 9.6 mGy (Body) DLP = 4.8
mGy-cm.
3) Spiral Acquisition 6.2 s, 48.6 cm; CTDIvol = 10.5 mGy (Body) DLP = 509.0
mGy-cm.
Total DLP (Body) = 515 mGy-cm.
COMPARISON: Comparison to CT abdomen from ___.
FINDINGS:
LOWER CHEST: Mild bibasilar atelectasis is noted.
ABDOMEN:
HEPATOBILIARY: A few subcentimeter hypodensities are too small to characterize
are stable. There is no biliary dilatation. The gallbladder is within normal
limits.
PANCREAS: Unremarkable. There is no peripancreatic stranding.
SPLEEN: Unremarkable.
ADRENALS: Unremarkable.
URINARY: There is a 3.1 cm simple cyst within the left lower renal pole
(02:32). Additional hypodensities within the right renal cortex are too small
to characterize. A hypodense lesion in the right interpolar region (02:30,
601:37), may represent a cyst, however too small and intrarenal in location,
not further characterized and indeterminate. No hydronephrosis.
GASTROINTESTINAL: There is a moderate sized hiatal hernia. There is a large
inflamed small bowel diverticulum with nearby edema, soft tissue stranding
(02:39) and multiple locules of free intraperitoneal air concerning for
perforation.
PELVIS: There is no free fluid in the pelvis. Again seen is an enlarged,
fibroid uterus.
LYMPH NODES: There is no abdominal or pelvic lymphadenopathy.
VASCULAR: There is no abdominal aortic aneurysm. Mild atherosclerotic disease
is noted.
BONES: There is no evidence of worrisome osseous lesions.
IMPRESSION:
1. Findings are compatible with perforated small bowel diverticulitis.
2. Bilateral renal cysts and additional hypodense lesions that are
indeterminate or too small to characterize.
3. Moderate-sized hiatal hernia.
4. Colonic diverticulosis without evidence of diverticulitis.
NOTIFICATION: The updated findings were discussed with ___, M.D.
by ___, M.D. on the telephone on ___ at 08:55 am, shortly
after discovery of the findings.
|
19958279-RR-17 | 19,958,279 | 27,775,101 | RR | 17 | 2177-12-05 02:49:00 | 2177-12-05 05:31:00 | EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: History: ___ with acute on chronic SDH on OSH MRI// Eval
evolution of SDH
TECHNIQUE: Contiguous axial images from skullbase to vertex were obtained
without intravenous contrast. Coronal and sagittal reformations and bone
algorithms reconstructions were also performed.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 16.0 s, 16.2 cm; CTDIvol = 49.7 mGy (Head) DLP =
802.7 mGy-cm.
Total DLP (Head) = 803 mGy-cm.
COMPARISON: None.
FINDINGS:
A mixed density left-sided subdural collection with both hyperdense and
isodense components overlying the left frontoparietal convexity measures up to
2.1 cm at its largest diameter. There is 7 cm of rightward shift of normally
midline structures. There is no evidence of intraparenchymal hemorrhage. The
basal cisterns are patent. No definite ventriculomegaly is noted. Bilateral
basal ganglia probable prominent perivascular spaces are noted.
There is no evidence of acute territorial infarction.
No osseous abnormalities seen. The paranasal sinuses are clear. There is
minimal fluid in the left mastoid air cells. The right mastoid air cells are
within normal limits.
IMPRESSION:
1. Please note no prior exam was submitted for direct comparison.
2. Acute on chronic left subdural hematoma measures up to 2.1 cm at its
largest diameter.
3. There is 7 mm of rightward shift of normally midline structures.
4. Nonspecific left mastoid fluid.
5. Probable bilateral basal ganglia prominent perivascular spaces. If
clinically indicated, consider correlation with patient's reported recent
outside brain MRI.
|
19958279-RR-18 | 19,958,279 | 27,775,101 | RR | 18 | 2177-12-05 17:05:00 | 2177-12-05 18:18:00 | EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: ___ year old woman with left SDH// left SDH
TECHNIQUE: Contiguous axial images from skullbase to vertex were obtained
without intravenous contrast.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 4.0 s, 16.0 cm; CTDIvol = 46.7 mGy (Head) DLP =
747.3 mGy-cm.
Total DLP (Head) = 747 mGy-cm.
COMPARISON: Noncontrast CT head from ___ at 02:49.
FINDINGS:
There has been interval evacuation of the left convexity extra-axial fluid
collection with expected postsurgical changes, pneumocephalus, and drain
terminating the left frontal subdural space. Mixed density extra-axial fluid
collection has substantially decreased in size, now measuring maximally 17 mm,
previously 31 mm. Previously demonstrated midline shift has essentially
resolved. No new hemorrhage is identified. No areas of hypodensity to
suggest infarct are seen. Mass-effect on the frontal horns of ventricles has
decreased, although a small amount remains. The basal cisterns are patent.
IMPRESSION:
1. Interval evacuation of the left subdural hematoma and drain placement with
substantial decreased size of the extra-axial fluid collection (although some
remains) and resolution of midline shift and decreased mass effect on the
lateral ventricles.
2. No new hemorrhage or CT evidence of infarct.
|
19958279-RR-19 | 19,958,279 | 27,775,101 | RR | 19 | 2177-12-07 15:30:00 | 2177-12-07 16:30:00 | EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: ___ year old woman ___ s/p left crani SDH evac- now s/p drain
removal.
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 4.0 s, 16.0 cm; CTDIvol = 46.7 mGy (Head) DLP =
747.3 mGy-cm.
Total DLP (Head) = 747 mGy-cm.
COMPARISON: ___ noncontrast head CTs
FINDINGS:
Patient is status-post left frontal craniotomy with associated postsurgical
changes including trace underlying pneumocephalus, subcutaneous emphysema,
cutaneous staples, and subcutaneous fat stranding. An extra-axial drain has
been removed. The mixed density subdural fluid collection appears unchanged
in size, now measuring 1.7 cm from the inner table at the craniotomy site
(series 2, image 24). Approximately 1 mm of midline shift is unchanged.
Effacement of the adjacent sulci is unchanged. The basilar cisterns are
patent. No evidence of new intracranial hemorrhage. No evidence of large
territorial infarction, edema, or mass. Hypo densities in the bilateral basal
ganglia are unchanged.
The visualized portion of the paranasal sinuses, mastoid air cells, and middle
ear cavities are clear. The visualized portion of the orbits are
unremarkable.
IMPRESSION:
A mixed density subdural hematoma is unchanged in size since 2 days prior, now
status-post extra-axial drain removal. No evidence of new hemorrhage. The
ventricles are stable in size and configuration.
|
19958337-RR-32 | 19,958,337 | 24,150,470 | RR | 32 | 2152-10-28 14:34:00 | 2152-10-28 15:50:00 | HISTORY: Status post cesarean with massive hemorrhage complicated by ureteral
injury, peritonitis, and bilateral pulmonary emboli. Now with subjective
fever and a mild abdominal pain.
TECHNIQUE: Multi-detector CT imaging was performed from the thoracic inlet to
the pubic symphysis following the administration of 130 cc Omnipaque
intravenous contrast and enteric contrast. Coronal and sagittal reformatted
images were generated and reviewed.
DLP: ___
COMPARISON: Comparison is made to CT cystogram dated ___.
FINDINGS:
A small focus of airspace opacity is seen within the right lower lobe, likely
the residua of prior infarct. There has been interval resolution of a left
pleural effusion. The bases of the lungs are otherwise clear. The visualized
heart is normal in size and without pericardial effusion.
ABDOMEN: The liver enhances homogeneously without focal lesions. The portal
venous system is patent. No intrahepatic or extrahepatic biliary dilatation
is seen. An IVC filter is seen again, unchanged in location. The
gallbladder, pancreas, spleen, and bilateral adrenal glands are within normal
limits. Redemonstrated is a left-sided percutaneous nephrostomy tube which
terminates within the left renal pelvis. New subtle cortical sub-cm
hypodensities are seen within the upper pole of the left kidney possibly
infectious in etiology. The right kidney enhances symmetrically and is
without evidence of hydronephrosis or hydroureter.
The stomach, duodenum, and intra-abdominal loops of small and large bowel are
normal in caliber without evidence of wall thickening or obstruction. No free
air or abdominal ascites is present. There are no pathologically enlarged
mesenteric or retroperitoneal lymph nodes seen. The abdominal aorta is normal
in caliber throughout. The celiac artery and SMA are patent.
PELVIS: The patient is status post hysterectomy, and there has been interval
removal of a pelvic surgical drain. A bilobed, 4.2 x 3.0 cm rim-enhancing
residual left complex pelvic fluid collection is noted with several small foci
of gas inferiorly which displaces the bladder towards the right. This is
compatible with residual hematoma, but the presence of tiny foci of gas is
concerning for superimposed infection. Tiny foci of gas are seen within the
bladder lumen which may be secondary to recent instrumentation, or may
represent cystitis. High density embolization coils are noted again within
the left pelvis. There has been an interval decrease in the degree of left
pelvic fluid and fat stranding, as well as a significant interval decrease in
the size of a small left rectus hematoma.
BONES: No osseous destructive lesions concerning for malignancy are detected.
IMPRESSION:
1. Bilobed 4.2 x 3.0 cm complex rim-enhancing fluid collection in the left
pelvis is compatible with residual hematoma but the presence of multiple small
foci of gas inferiorly suggests superimposed infection.
2. Several subtle hypodensities seen within the left upper pole renal cortex
which may represent early infection.
3. Tiny focus of gas within the bladder, which may be secondary to recent
instrumentation versus infection.
|
19958337-RR-33 | 19,958,337 | 24,150,470 | RR | 33 | 2152-10-29 13:24:00 | 2152-10-29 16:37:00 | INDICATION: ___ woman with pelvic abscess, status post multiple
surgeries. Please aspirate pelvic abscess.
Comparison is made to CT from ___.
TECHNIQUE: Transvaginal pelvic imaging was performed to assess for
feasibility for drainage.
FINDINGS: There is a 5.1 x 0.9 cm linear structure lying between the rectum
and vagina. It is of homogeneous internal echoegenicity and likely correlates
with the bilobed possible collection on CT. There is no significant
vascularity associated with this area. The appearances are consistent with
residual hematoma/fluid rather than aan abscess. No large pelvic collection.
There is a 3.2 cm simple cyst within the right ovary, not completely assessed
on this study. The left ovary is normal in appearance.
The patient is status post hysterectomy.
IMPRESSION: 5 cm x 0.9 cm structure lying between the rectum and vaginal
vault. This demonstrates homogeneous echogenicity and may represent residual
post-surgery hematoma with no definite signs of infection.
In consultation with the referring team, the decision was made to defer
aspiration at this point.Followup is advised.
This result was discussed with Dr. ___ by Dr. ___ 3 p.m. on ___.
|
19958492-RR-46 | 19,958,492 | 24,369,516 | RR | 46 | 2134-11-06 03:37:00 | 2134-11-06 04:56:00 | EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN)
INDICATION: ___ with elevated all phos, evaluate for any abnormalities.
TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were
obtained.
COMPARISON: CT abdomen and pelvis dated ___
FINDINGS:
LIVER: There are innumerable rounded, centrally isoechoic, peripherally
hypoechoic lesions scattered throughout the liver, the largest measuring 2.8
cm in the right hepatic lobe. The contour of the liver is smooth. The main
portal vein is patent with hepatopetal flow. There is no ascites.
BILE DUCTS: There is no intrahepatic biliary dilation.
CHD: 7 mm
GALLBLADDER: The patient is status post cholecystectomy.
PANCREAS: The imaged portion of the pancreas appears within normal limits,
without masses or pancreatic ductal dilation, with portions of the pancreatic
tail obscured by overlying bowel gas.
SPLEEN: Normal echogenicity. A heterogeneous lesion at the splenic hilum
measuring 3.3 x 2.7 x 2.2 cm is seen and may represent an accessory spleen.
Spleen length: 13.9 cm
RETROPERITONEUM: The visualized portions of aorta and IVC are within normal
limits.
IMPRESSION:
1. Innumerable, rounded lesions scattered throughout the liver measuring up to
2.8 cm, new from prior study dated ___ and suspicious for hepatic
metastases. Oncology consult, targeted liver biopsy, and CT torso is
recommended for further evaluation.
2. Splenomegaly measuring 13.9 cm.
3. Heterogeneous lesion at the splenic hilum measuring 3.3 cm is incompletely
characterized but may represent an accessory spleen or an additional site of
malignancy.
RECOMMENDATION(S): Oncology consult, targeted liver biopsy, and CT torso is
recommended for further evaluation.
NOTIFICATION: The findings were discussed with ___, M.D. by
___, M.D. on the telephone on ___ at 4:30 am, 1
minutes after discovery of the findings.
|
19958492-RR-47 | 19,958,492 | 24,369,516 | RR | 47 | 2134-11-06 11:18:00 | 2134-11-06 12:02:00 | EXAMINATION: CT ABD AND PELVIS W AND W/O CONTRAST, ADDL SECTIONS
INDICATION: ___ year old woman with weakness and elevated alk phos found to
have innumerable lesions in liver on RUQ US concerning for malignancy// eval
malignancy
TECHNIQUE: Single phase contrast: MDCT axial images were acquired through the
abdomen and pelvis following intravenous contrast administration.
Oral contrast was administered.
Coronal and sagittal reformations were performed and reviewed on PACS.
DOSE: Acquisition sequence:
1) Spiral Acquisition 7.9 s, 30.3 cm; CTDIvol = 5.4 mGy (Body) DLP = 156.1
mGy-cm.
2) Stationary Acquisition 0.5 s, 1.0 cm; CTDIvol = 1.2 mGy (Body) DLP = 1.2
mGy-cm.
3) Stationary Acquisition 2.5 s, 1.0 cm; CTDIvol = 5.8 mGy (Body) DLP = 5.8
mGy-cm.
4) Spiral Acquisition 7.8 s, 30.0 cm; CTDIvol = 13.3 mGy (Body) DLP = 377.2
mGy-cm.
5) Spiral Acquisition 13.0 s, 49.9 cm; CTDIvol = 16.1 mGy (Body) DLP =
778.5 mGy-cm.
6) Spiral Acquisition 7.9 s, 30.5 cm; CTDIvol = 13.3 mGy (Body) DLP = 384.1
mGy-cm.
Total DLP (Body) = 1,716 mGy-cm.
COMPARISON: Ultrasound liver/gall bladder ___
CT abdomen pelvis ___.
FINDINGS:
LOWER CHEST: There is mild bibasilar dependent atelectasis.. There is no
evidence of pleural or pericardial effusion. There are no solid pulmonary
nodules.
ABDOMEN:
HEPATOBILIARY: There are innumerable hypoattenuating variable-sized rounded
lesions scattered throughout the liver measuring up to 4.6 x 5.4 x 4.6 cm.
There is no evidence of intrahepatic or extrahepatic biliary dilatation. The
patient is status post cholecystectomy.
PANCREAS: There is a hypoattenuating mass within the tail the pancreas
measuring approximately 3.4 x 1.7 x 2.3 cm (series 12, image 44). There is no
associated pancreatic ductal dilatation. There is no peripancreatic
stranding.
SPLEEN: The spleen shows normal size and attenuation throughout, without
evidence of focal lesions. The splenic vein is thrombosed.
ADRENALS: There is a hypoattenuating lesion within the left adrenal gland
measuring 1.5 by 1.2 by 1.5 cm (series 12, image 43). The right adrenal gland
is unremarkable.
URINARY: The kidneys are of normal and symmetric size with normal nephrogram.
There is a subcentimeter hypoattenuating cystic lesion within the left kidney
which is too small to characterize. There is no hydronephrosis. There is no
perinephric abnormality.
GASTROINTESTINAL: No bowel obstruction. Extensive perigastric varices are
noted, likely related to splenic vein thrombosis.
PELVIS: The urinary bladder and distal ureters are unremarkable. There is
small volume free fluid in the pelvis.
REPRODUCTIVE ORGANS: The uterus and both ovaries appear unremarkable.
LYMPH NODES: There are subcentimeter short axis porta hepaticus lymph nodes.
There is no pelvic or inguinal lymphadenopathy.
VASCULAR: There is thrombosis of the splenic vein. There is no abdominal
aortic aneurysm. Mild atherosclerotic disease is noted.
BONES: There are chronic degenerative changes of the thoracolumbar spine.
Facetal arthropathy is noted in the lumbar spine. There is no evidence of
worrisome osseous lesions or acute fracture.
SOFT TISSUES: The abdominal and pelvic wall is within normal limits.
IMPRESSION:
1. Hypoattenuating mass within the pancreatic tail measuring up to 3.4 cm in
size with associated adjacent splenic vein thrombosis is concerning for a
primary pancreatic tail malignancy. No main pancreatic duct dilation.
2. There are innumerable hypoattenuating lesions throughout the liver
compatible with metastases. Left adrenal nodule measuring 1.5 cm is also
concerning for a metastatic lesion.
RECOMMENDATION(S): Targeted liver biopsy for histopathologic confirmation.
|
19958492-RR-48 | 19,958,492 | 24,369,516 | RR | 48 | 2134-11-06 21:12:00 | 2134-11-07 08:32:00 | EXAMINATION: MR HEAD W AND W/O CONTRAST ___ MR HEAD
INDICATION: ___ year old woman with h/o hemorrhagic stroke presenting with
generalized fatigue and new liver lesions c/f malignancy// metastasis?
TECHNIQUE: Sagittal and axial T1 weighted imaging were performed. After
administration of intravenous contrast, axial imaging was performed with
gradient echo, FLAIR, diffusion, and T1 technique. Sagittal MPRAGE imaging was
performed and re-formatted in axial and coronal orientations.
COMPARISON: CT head ___, CT head ___.
FINDINGS:
Some of the sequences have been degraded by movement artifact.
There is a 4 mm focus of enhancement in the left cerebellar hemisphere
superiorly, abutting the left tentorium cerebelli. There is no surrounding
edema. There is no abnormal leptomeningeal enhancement. There is
encephalomalacia in the right parietal and superior aspect of the right
occipital lobe, and also in the splenium of the corpus callosum, in keeping
with the previous hemorrhage. There is surrounding T2/FLAIR hyperintensity,
which likely represents gliosis. There is hemosiderin staining on gradient
echo sequence at the periphery of the area of encephalomalacia, in keeping
with previous hemorrhage. There are a few foci of blooming in the right
frontal lobe, in keeping with previous microhemorrhage. There is no evidence
of mass effect, midline shift or infarction. There is ex vacuo dilatation of
the trigone and occipital horn of the right lateral ventricle secondary to the
adjacent encephalomalacia.
IMPRESSION:
-4 mm focus of enhancement in the left cerebellar hemisphere superiorly
abutting the left tentorium cerebelli. Differential considerations include a
benign process such as a small meningioma, however a focal solitary metastatic
lesion cannot definitively be excluded.
-Encephalomalacia and surrounding gliosis in the right parietal and superior
aspect of the right occipital lobe, in keeping with previous hemorrhage.
-There are few foci of blooming on gradient echo within the right frontal
lobe, in keeping with previous microhemorrhage.
Recommendations:
Three-month follow-up with MRI of the head is recommended to evaluate for
interval change.
|
19958492-RR-49 | 19,958,492 | 24,369,516 | RR | 49 | 2134-11-08 10:27:00 | 2134-11-08 12:42:00 | EXAMINATION: MR HEAD W AND W/O CONTRAST T___ MR HEAD
INDICATION: ___ year old woman with motion artifact on prior MRI// repeat
imaging for cerebellar lesion given prior study limited by motion artifact
TECHNIQUE: Sagittal and axial T1 weighted imaging were performed. After
administration of intravenous contrast, axial imaging was performed with
gradient echo, FLAIR, diffusion, and T1 technique. Sagittal MPRAGE imaging was
performed and re-formatted in axial and coronal orientations.
COMPARISON: ___ contrast brain MRI.
___ noncontrast head CT.
FINDINGS:
Study is severely degraded by motion, especially on postcontrast images.
Within these confines:
Right parieto-occipital remote hemorrhage related encephalomalacia. Grossly
stable nonspecific curvilinear enhancement within the area of encephalomalacia
is again seen (see 100:115 current study and 101:111 on prior exam).
Additional punctate right frontal focus of chronic blood products versus
mineralization is noted (see 10:15).
Left cerebellar approximately 4 mm focal enhancement is again seen on
postcontrast imaging (see 13:7; 17:62; series 18 on current study and 14:64;
15:8 on ___ prior exam).
There is no evidence of hemorrhage, edema, mass effect, midline shift or
infarction. The ventricles and sulci are stable in caliber and
configuration.
IMPRESSION:
1. Study is severely degraded by motion.
2. No definite evidence of acute infarct.
3. Grossly stable approximately 4 mm left cerebellar enhancing mass. While
finding may represent artifact, or dural-based mass such as meningioma,
metastatic disease is not excluded on the basis of this examination. Again,
recommend three-month follow-up evaluation for stability or comparison with
outside contrast brain MRI if available for comparison.
4. Right parieto-occipital remote hemorrhage related encephalomalacia.
5. Grossly stable right frontal punctate chronic blood products versus
mineralization.
RECOMMENDATION(S): Grossly stable approximately 4 mm left cerebellar
enhancing mass. While finding may represent artifact, or dural-based mass such
as meningioma, metastatic disease is not excluded on the basis of this
examination. Again, recommend three-month follow-up evaluation for stability
or comparison with outside contrast brain MRI if available for comparison.
|
19958492-RR-51 | 19,958,492 | 24,369,516 | RR | 51 | 2134-11-09 07:52:00 | 2134-11-09 09:08:00 | EXAMINATION: Ultrasound-guided targeted liver biopsy.
INDICATION: ___ year old woman with h/o hemorrhagic stroke ___ presenting
with wks of generalized fatigue now with CT abdomen with multiple liver
lesions and pancreatic lesion c/f malignancy poss pancreatic primary*Please
put rush on pathology// malignancy with mets to liver? primary unknown.
COMPARISON: Ultrasound ___.
PROCEDURE: Ultrasound-guided targeted liver biopsy.
OPERATORS: Dr. ___, radiology trainee and Dr. ___,
attending radiologist. Dr. ___ personally supervised the trainee
during the key components of the procedure and reviewed and agrees with the
trainee's findings.
FINDINGS:
Limited preprocedure grayscale and Doppler ultrasound imaging of the liver was
performed, demonstrating extensive liver metastases.. The lesion for biopsy
was identified in the right hepatic lobe. A suitable approach for targeted
liver biopsy was determined.
TECHNIQUE: The risks, benefits, and alternatives of the procedure were
explained to the patient. After a detailed discussion, informed written
consent was obtained. A pre-procedure timeout using three patient identifiers
was performed per ___ protocol.
Based on the preprocedure imaging, an appropriate skin entry site for the
biopsy was chosen. The site was marked. The skin was then prepped and draped
in the usual sterile fashion. The superficial soft tissues to the liver
capsule were anesthetized with 10 mL 1% lidocaine.
Under real-time ultrasound guidance, 3 18-gauge core biopsy passes were made.
The sample was placed in formalin.
The skin was then cleaned and a dry sterile dressing was applied. There were
no immediate complications.
SEDATION: Moderate sedation was provided by administering divided doses of 1
mg Versed and 50 mcg fentanyl throughout the total intra-service time of 14
minutes during which patient's hemodynamic parameters were continuously
monitored by an independent trained radiology nurse.
IMPRESSION:
Uncomplicated 18-gauge targeted liver biopsy x 3, with specimen sent to
pathology.
|
19958492-RR-53 | 19,958,492 | 24,369,516 | RR | 53 | 2134-11-10 17:40:00 | 2134-11-10 19:05:00 | EXAMINATION: CT CHEST W/CONTRAST ___
INDICATION: ___ year old woman with liver lesions and pancreatic tail lesion
c/f pancreatic primary// likely pancreatic ca staging
TECHNIQUE: Multi detector helical scanning of the chest was reconstructed as
5 and 1.25 mm thick axial, 2.5 mm thick coronal and parasagittal, and 8 mm MIP
axial images. Contrast agent was not administered. All images were reviewed.
DOSE: Acquisition sequence:
1) Spiral Acquisition 2.0 s, 31.7 cm; CTDIvol = 13.2 mGy (Body) DLP = 418.9
mGy-cm.
Total DLP (Body) = 419 mGy-cm.
COMPARISON: Chest CT scans ___ and ___
FINDINGS:
CHEST PERIMETER: No thyroid findings need any further imaging evaluation.
Supraclavicular and axillary lymph nodes are not enlarged. Breast evaluation
is reserved exclusively for mammography.
No soft tissue abnormality elsewhere in the partially imaged chest wall.
This study is not appropriate for subdiaphragmatic diagnosis, last evaluated
by CT of the abdomen on ___.
CARDIO-MEDIASTINUM: Esophagus is unremarkable. Atherosclerotic calcification
is not apparent in head neck vessels or coronary arteries. Aorta and
pulmonary arteries and cardiac chambers are normal size. Pericardium is
physiologic.
THORACIC LYMPH NODES: No lymph nodes in the chest are pathologically enlarged
or growing, including posterior mediastinal and diaphragmatic stations.
LUNGS, AIRWAYS, PLEURAE: Lung volumes are low, attributable to elevation of
the diaphragm by hepatosplenomegaly which causes discrete atelectasis in both
lower lungs and exaggerates heterogeneity in background density which could be
early edema. No lung nodules or discrete consolidation. Right pleural
effusion is minimal. No pleural mass.
CHEST CAGE: Although there are no bone lesions in the imaged chest cage
suspicious for malignancy or infection, it should be noted that radionuclide
bone and FDG PET scanning are more sensitive in detecting early osseous
pathology than chest CT scanning.
IMPRESSION:
No evidence of intrathoracic malignancy.
|
19958492-RR-55 | 19,958,492 | 24,369,516 | RR | 55 | 2134-11-11 19:59:00 | 2134-11-11 22:08:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old woman with altered mental status.// Please rule out
pneumonia.
TECHNIQUE: AP portable chest radiograph
COMPARISON: CT scan of the chest dated ___
FINDINGS:
Bibasilar opacities, left greater than right likely reflect atelectasis.
There is new pulmonary vascular congestion without overt pulmonary edema. No
pneumothorax or pleural effusion. The size of the cardiac silhouette is
within normal limits.
IMPRESSION:
New pulmonary vascular congestion without overt pulmonary edema. Bibasilar
atelectasis.
|
19958492-RR-56 | 19,958,492 | 24,369,516 | RR | 56 | 2134-11-11 20:39:00 | 2134-11-11 22:04:00 | EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: ___ year old woman with altered mental status, please rule out
bleed or large territory infarct
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 4.0 s, 16.0 cm; CTDIvol = 46.7 mGy (Head) DLP =
747.4 mGy-cm.
Total DLP (Head) = 747 mGy-cm.
COMPARISON: MRI brain dated ___ and CT head dated ___
FINDINGS:
There is no evidence of acute infarction,hemorrhage,edema, or mass. There is
redemonstration of right parietooccipital lobe encephalomalacia from remote
intracranial hemorrhage. The previously described 4 mm left cerebellar
enhancing mass is suboptimally evaluated on a noncontrast CT. There is
prominence of the ventricles and sulci suggestive of involutional changes.
There is no evidence of fracture. The visualized portion of the paranasal
sinuses, mastoid air cells, and middle ear cavities are clear. The visualized
portion of the orbits are unremarkable.
IMPRESSION:
No acute intracranial process. Specifically, no evidence of acute infarction
or intracranial hemorrhage.
|
19958502-RR-9 | 19,958,502 | 20,046,734 | RR | 9 | 2131-10-13 14:52:00 | 2131-10-13 16:28:00 | HISTORY: Status post renal transplant in ___ with diarrhea, vomiting and
creatinine of 7. Evaluate for hydronephrosis
TECHNIQUE: Grayscale and Doppler ultrasound images of the renal transplant
were obtained.
COMPARISON: None available
FINDINGS:
The renal morphology is normal. Specifically the cortex is of normal
thickness and echogenicity, pyramids are normal, there is no
pelvi-infundibular thickening and the renal sinus fat is normal. There is no
hydronephrosis and no perinephric fluid collection.
The resistive index of the intrarenal arteries ranges from 0.71-0.86.
Acceleration times and peak systolic velocities of the main renal artery are
normal. Vascularity is symmetric throughout transplants. There is a focal
area of aliasing within the main renal vein. The renal vein is patent.
The bladder is decompressed and cannot be evaluated. A large fibroid is
partially visualized.
IMPRESSION:
1. No evidence of hydronephrosis.
2. Questionable area of venous stenosis within the main renal vein, probably
artifactual.
|
19958540-RR-18 | 19,958,540 | 21,189,178 | RR | 18 | 2174-09-08 17:45:00 | 2174-09-08 18:22:00 | HISTORY: Right lower extremity swelling.
TECHNIQUE: Grayscale, color Doppler and spectral Doppler evaluation was
performed of the bilateral lower extremity veins.
COMPARISON: None unavailable.
FINDINGS:
There is normal compressibility, flow, and augmentation of the right common
femoral, proximal femoral, mid femoral, distal femoral, and popliteal veins.
Normal color flow and compressibility are demonstrated in the posterior tibial
and peroneal veins. There is normal respiratory variation in the common
femoral veins bilaterally.
IMPRESSION:
No evidence of deep vein thrombosis in the right lower extremity.
|
19958540-RR-19 | 19,958,540 | 21,189,178 | RR | 19 | 2174-09-11 10:36:00 | 2174-09-11 11:35:00 | EXAMINATION: CHEST PORT. LINE PLACEMENTCHEST PORT. LINE PLACEMENTi
INDICATION: ___ year old man with PICC // Pt had a left picc,53cm ___
___ Contact name: ___: ___
COMPARISON: Chest radiographs ___.
IMPRESSION:
Left PIC line ends in the low SVC. Normal heart, lungs, hila, mediastinum, and
pleural surfaces. No evidence of intrathoracic malignancy or infection.
|
19958808-RR-21 | 19,958,808 | 29,990,340 | RR | 21 | 2123-07-11 19:49:00 | 2123-07-11 20:48:00 | EXAMINATION: LIVER OR GALLBLADDER US (SINGLE ORGAN)
INDICATION: History: ___ with RUQ pain, septic// ? cholecystitis
TECHNIQUE: Grey scale and color Doppler ultrasound images of the abdomen were
obtained.
COMPARISON: None.
FINDINGS:
LIVER: The liver is diffusely echogenic. The contour of the liver is smooth.
There is no focal liver mass. The main portal vein is patent with hepatopetal
flow. There is no ascites.
BILE DUCTS: There is no intrahepatic biliary dilation.
CHD: 0.4 cm
GALLBLADDER: There is no evidence of stones or gallbladder wall thickening.
PANCREAS: The pancreas is not well visualized, largely obscured by overlying
bowel gas.
SPLEEN: Normal echogenicity.
Spleen length: 11.0 cm
KIDNEYS: Limited views of the kidneys show no hydronephrosis.
Right kidney: 10.8 cm
Left kidney: 11.6 cm.
RETROPERITONEUM: The visualized portions of aorta and IVC are within normal
limits.
IMPRESSION:
1. Echogenic liver consistent with steatosis. Other forms of liver disease
including steatohepatitis, hepatic fibrosis, or cirrhosis cannot be excluded
on the basis of this examination.
2. No cholelithiasis or evidence of acute cholecystitis.
|
19958808-RR-22 | 19,958,808 | 29,990,340 | RR | 22 | 2123-07-14 14:32:00 | 2123-07-14 16:14:00 | EXAMINATION: FOOT AP,LAT AND OBL RIGHT
INDICATION: ___ year old woman with alcoholic hepatitis and right foot
cellulitis with recent trauma// please evaluate for fracture vs. soft tissue
gas
TECHNIQUE: Frontal, oblique and lateral radiographs of the right foot.
COMPARISON: None
FINDINGS:
There is no fracture or dislocation of the right foot. There is no bone loss
or destruction. Joint spaces are preserved. There is soft tissue swelling of
the dorsum of the foot. There is no soft tissue gas.
IMPRESSION:
1. No fracture of the right foot.
2. No radiographic findings of osteomyelitis, noting that MRI is more
sensitive for early osteomyelitis.
|
19958882-RR-16 | 19,958,882 | 24,100,077 | RR | 16 | 2171-08-04 11:43:00 | 2171-08-04 17:36:00 | INDICATION: Pain and shortness of breath.
COMPARISON: Chest radiograph ___.
FINDINGS: Single AP view of the chest was obtained for review. A right chest
port is noted with tip near the cavoatrial junction. Cardiomediastinal and
hilar contours are unchanged. There are small bilateral pleural effusions,
right greater than left. There is no pneumothorax. Multiple masses are seen
within both lungs, better assessed by concurrent chest CTA.
|
19958882-RR-17 | 19,958,882 | 24,100,077 | RR | 17 | 2171-08-04 12:05:00 | 2171-08-04 16:48:00 | INDICATION: Chest pain and shortness of breath with non-small cell
adenocarcinoma of the lungs metastatic to liver.
COMPARISON: CT chest ___.
TECHNIQUE: Axial MDCT images were taken through the chest in the arterial
phase after the administration of 100 cc Omnipaque intravenous contrast
material. Coronal and sagittal reformats were also examined, as well as
maximum intensity oblique projection images.
FINDINGS:
CTA: The aorta and pulmonary arteries are well opacified. The aorta
maintains a normal contour without any evidence of acute aortic syndrome.
There is no pulmonary embolism in the main, right, left, lobar, or
subsegmental pulmonary arteries.
There has been interval increase in the size of multiple pulmonary metastases,
some with central necrosis and cavitation. Additionally, there is an increase
in the mediastinal nodal conglomerate, causing slight flattening of the main
pulmonary artery (602B:41) due to mass effect. Additionally a right
infrahilar mass is enlarged compared to the prior study and is again seen
encasing and obliterating the right lower lobe bronchus. This mass also
encases and attenuates the pulmonary veins and compress the left atrium,
worsened compared to the prior study. Additionally, tumoral implants in the
pericardium adjacent to the left ventricle free wall and anterior to the right
atrium are noted. There are small bilateral pleural effusions, new since the
prior study.
There has been increase in multiple hepatic metastases involving both lobes of
the liver. Additionally an enlarging mass in the region of the GE junction
compressing the stomach is likely an enlarged lymph node. The remainder of
the visualized portion of the upper abdomen is unremarkable.
No suspicious lesion is seen in visualized osseous structures.
IMPRESSION:
1. No pulmonary embolism or evidence of acute aortic syndrome.
2. Tumor progression with increase in size of multiple pulmonary and hepatic
lesions. Enlarging right infrahilar mass is now encasing and severly
attenuating the right pulmonary venous confluence at the left atrium.
|
19958954-RR-27 | 19,958,954 | 28,456,141 | RR | 27 | 2139-12-23 16:14:00 | 2139-12-23 16:44:00 | INDICATION: Evaluate for rib fractures in a patient status post fall.
COMPARISON: CTA chest from ___ and chest radiographs from ___ and ___.
FINDINGS:
A portable frontal chest radiograph demonstrates a normal cardiomediastinal
silhouette and hyperinflated lungs compatible with emphysema. No focal
consolidation, pleural effusion, or pneumothorax. No displaced rib fracture
is identified. The visualized upper abdomen is unremarkable.
IMPRESSION:
1. No displaced rib fracture identified. If there is continued concern,
dedicated rib radiographs can be obtained.
2. Hyperinflated lungs, consistent with known emphysema.
|
19958954-RR-28 | 19,958,954 | 28,456,141 | RR | 28 | 2139-12-23 17:47:00 | 2139-12-23 18:51:00 | EXAMINATION: CT HEAD W/O CONTRAST
INDICATION: Status post fall with head injury.
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast. Reformatted images in coronal and sagittal axes were generated.
DOSE: This study involved 4 CT acquisition phases with dose indices as
follows:
1) CT Localizer Radiograph
2) CT Localizer Radiograph
3) Sequenced Acquisition 16.0 s, 17.4 cm; CTDIvol = 46.0 mGy (Head) DLP =
802.7 mGy-cm.
4) Sequenced Acquisition 1.0 s, 2.0 cm; CTDIvol = 50.2 mGy (Head) DLP =
100.3 mGy-cm.
Total DLP (Head) = 903 mGy-cm.
COMPARISON: Noncontrast CT head from ___.
FINDINGS:
There is no evidence of acute large territorial infarction, hemorrhage, edema,
or mass effect. A chronic left caudate head lacunar infarct is noted.
Prominent ventricles and sulci are suggestive of age-related involutional
change. Mild periventricular white matter hypodensities are consistent with
chronic small vessel ischemic disease. Dense atherosclerotic calcifications
are seen within the cavernous carotid arteries as well as distal left
vertebral artery.
There is no evidence of fracture. The visualized portion of the paranasal
sinuses, mastoid air cells, and middle ear cavities are clear. There is soft
tissue swelling and hematoma in the extracranial soft tissues overlying the
left orbit. Both globes are intact without retrobulbar hematoma.
IMPRESSION:
1. No acute intracranial abnormality. Soft tissue swelling and hematoma in
the extracranial soft tissues about the left orbit. Globes intact.
2. Age-related involutional changes and mild sequela of chronic small vessel
ischemic disease.
|
19958954-RR-29 | 19,958,954 | 28,456,141 | RR | 29 | 2139-12-23 17:47:00 | 2139-12-23 19:12:00 | EXAMINATION: CT C-SPINE W/O CONTRAST
INDICATION: Status post fall.
TECHNIQUE: Non-contrast helical multidetector CT was performed. Axial image
data was collimated to display separate 2.5 mm soft tissue and bone algorithm
axial images. Coronal and sagittal reformations were then constructed.
DOSE: This study involved 3 CT acquisition phases with dose indices as
follows:
1) CT Localizer Radiograph
2) CT Localizer Radiograph
3) Spiral Acquisition 5.3 s, 20.8 cm; CTDIvol = 36.7 mGy (Body) DLP = 765.0
mGy-cm.
Total DLP (Body) = 765 mGy-cm.
COMPARISON: Noncontrast CT cervical spine from ___.
FINDINGS:
There is no acute fracture, malalignment, or prevertebral soft tissue
abnormality. Calcification of the nuchal ligament at the C4 and 5 levels is
unchanged. There moderate multilevel degenerative changes, with mild spinal
canal narrowing and mild bilateral neural foraminal narrowing at the C5-6 and
C6-7 levels, unchanged. Emphysema with bulla lung apices, more pronounced on
the right, is again seen. The thyroid gland is unremarkable. There are
bilateral carotid bifurcation calcifications.
IMPRESSION:
No acute fracture, malalignment, or prevertebral soft tissue abnormality.
|
19958954-RR-30 | 19,958,954 | 28,456,141 | RR | 30 | 2139-12-23 17:48:00 | 2139-12-23 19:07:00 | EXAMINATION: CT SINUS/MANDIBLE/MAXILLOFACIAL W/O CONTRAST
INDICATION: Evaluate for orbital fracture in a patient with facial trauma.
TECHNIQUE: Helically-acquired multidetector CT axial images were obtained
through the maxillofacial bones and mandible. Intravenous contrast was not
administered. Axial images reconstructed with soft tissue and bone algorithm
to display images with 1.25 mm slice. Coronal and sagittal reformations were
also constructed. All produced images were evaluated in production of this
report.
DOSE: This study involved 3 CT acquisition phases with dose indices as
follows:
1) CT Localizer Radiograph
2) CT Localizer Radiograph
3) Spiral Acquisition 2.0 s, 15.4 cm; CTDIvol = 25.0 mGy (Head) DLP = 385.1
mGy-cm.
Total DLP (Head) = 385 mGy-cm.
COMPARISON: None.
FINDINGS:
There is left periorbital soft tissue swelling without underlying fracture.
No acute fracture is identified. The paranasal sinuses are clear. The globes
are intact. No retrobulbar hematoma is present. Visualized paranasal sinuses
are clear. Atherosclerotic calcifications of the cavernous carotid and distal
left vertebral arteries are present.
IMPRESSION:
Left periorbital soft tissue swelling without underlying fracture.
|
19958954-RR-31 | 19,958,954 | 28,456,141 | RR | 31 | 2139-12-23 17:48:00 | 2139-12-23 19:29:00 | EXAMINATION: CT L-SPINE W/O CONTRAST
INDICATION: Lower lumbar tenderness on exam, in a patient status post fall.
Evaluate for fracture.
TECHNIQUE: Non-contrast helical multidetector CT was performed. Axial image
data was collimated to display separate 2.5 mm soft tissue and bone algorithm
axial images. Coronal and sagittal reformations were then constructed.
DOSE: This study involved 4 CT acquisition phases with dose indices as
follows:
1) CT Localizer Radiograph
2) CT Localizer Radiograph
3) CT Localizer Radiograph
4) Spiral Acquisition 6.8 s, 26.6 cm; CTDIvol = 31.8 mGy (Body) DLP = 846.3
mGy-cm.
Total DLP (Body) = 846 mGy-cm.
COMPARISON: CT abdomen/ pelvis from ___.
FINDINGS:
There is no acute fracture, malalignment, or prevertebral soft tissue
abnormality. There are moderate degenerative changes at the L1-2 level, with
sclerosis and subchondral cyst formation. There is bilateral L5 spondylolysis
without spondylolisthesis. There is no critical spinal canal stenosis. Mild
bilateral neural foraminal narrowing is noted L4-5. The visualized pre and
paravertebral soft tissues are unremarkable.
As seen previously, multiple pancreatic calcifications are re- demonstrated
with dilatation of the pancreatic duct measuring up to 6 mm, compatible with
chronic pancreatitis. Mild calcified atherosclerotic disease is seen within
the abdominal aorta.
IMPRESSION:
No acute fracture, malalignment, or prevertebral soft tissue abnormality.
|
19958954-RR-32 | 19,958,954 | 28,456,141 | RR | 32 | 2139-12-25 20:34:00 | 2139-12-25 21:09:00 | EXAMINATION: VENOUS DUP UPPER EXT UNILATERAL
INDICATION: ___ year old man with personality disorder/anger management
issues, poorly controlled type 2 diabetes mellitus presents with hypoglycemia
and syncope, complaints of worsening pain/swelling of right arm
TECHNIQUE: Grey scale and Doppler evaluation was performed on the right upper
extremity veins.
COMPARISON: None.
FINDINGS:
There is normal flow with respiratory variation in the bilateral subclavian
veins.
The right internal jugular and axillary veins are patent and compressible with
transducer pressure.
The right brachial, basilic, and cephalic veins are patent, compressible with
transducer pressure and show normal color flow and augmentation.
There is moderate subcutaneous edema throughout the right upper extremity.
IMPRESSION:
No evidence of deep vein thrombosis in the right upper extremity. Moderate
subcutaneous edema within the right upper extremity.
|
19958954-RR-33 | 19,958,954 | 28,456,141 | RR | 33 | 2139-12-25 17:33:00 | 2139-12-26 00:14:00 | EXAMINATION: Right humerus
INDICATION: ___ year old man s/p syncope with fall c/o pain to R arm //
?fracture
TECHNIQUE: Two views of right humerus
COMPARISON: Right shoulder radiograph ___
FINDINGS:
No acute fracture or dislocation. There are mild degenerative changes at the
acromioclavicular joint. The glenohumeral joint and elbow joint are grossly
intact. Soft tissues are unremarkable. Visualized lung is clear.
IMPRESSION:
No fracture.
|
19958954-RR-34 | 19,958,954 | 28,456,141 | RR | 34 | 2139-12-26 09:04:00 | 2139-12-26 09:59:00 | EXAMINATION: CHEST (PORTABLE AP)
INDICATION: ___ year old man with pleuritic chest pain // Pneumonia? Edema?
Effusion? Pneumothorax?
COMPARISON: ___.
IMPRESSION:
As compared to the previous radiograph, no relevant change is seen. No
pneumothorax. No pneumonia, no pulmonary edema. Normal size of the heart.
|
19958954-RR-43 | 19,958,954 | 29,040,322 | RR | 43 | 2141-11-22 13:39:00 | 2141-11-22 16:37:00 | EXAMINATION: CHEST (PA AND LAT)
INDICATION: ___ with AMS found down// r/o PNA
COMPARISON: None
FINDINGS:
AP and lateral views of the chest provided.
Mildly increased interstitial prominence and hyperinflation may be related to
chronic obstructive pulmonary disease. There is no pleural effusion or
pneumothorax. There are atherosclerotic calcifications and tortuosity of the
aorta. Coronary artery stent is also noted. Cardiomediastinal silhouette is
within normal limits.
IMPRESSION:
No definite focal consolidation. Hyperinflation.
|
19958954-RR-44 | 19,958,954 | 29,040,322 | RR | 44 | 2141-11-22 13:53:00 | 2141-11-22 14:14:00 | EXAMINATION: CT HEAD W/O CONTRAST.
INDICATION: History: ___ with AMS found down// r/o SDH, ICH.
TECHNIQUE: Contiguous axial images from skullbase to vertex were obtained
without intravenous contrast. Coronal and sagittal reformations and bone
algorithms reconstructions were also performed.
DOSE: Acquisition sequence:
1) Sequenced Acquisition 16.0 s, 17.5 cm; CTDIvol = 45.8 mGy (Head) DLP =
802.7 mGy-cm.
2) Sequenced Acquisition 4.0 s, 4.4 cm; CTDIvol = 45.8 mGy (Head) DLP =
200.7 mGy-cm.
Total DLP (Head) = 1,003 mGy-cm.
COMPARISON: None.
FINDINGS:
There is no evidence of acute intracranial hemorrhage, mass, mass effect or
shifting of the normally midline structures. The ventricles and sulci are
prominent suggesting cortical volume loss for the patient's age. Confluent
areas of low attenuation are demonstrated in the subcortical and
periventricular white matter, which are nonspecific and may reflect areas of
small vessel disease, which is also unusual in this age group, please
correlate. Dense vascular arteriosclerotic calcifications are present the
carotid siphons bilaterally as well as the left vertebral artery. No
fractures are identified. The soft tissues and bony structures are
unremarkable, the mastoid air cells are clear.
IMPRESSION:
There is no evidence of acute intracranial process, however the ventricles and
sulci are prominent for the patient's age. Areas of low attenuation in the
subcortical and periventricular white matter are nonspecific and may reflect
changes due to small vessel disease, which is also unusual in this age group,
please correlate.
|
19959499-RR-71 | 19,959,499 | 29,332,991 | RR | 71 | 2174-07-06 11:49:00 | 2174-07-06 13:35:00 | INDICATION: ___ male with dyspnea. Evaluate for pneumonia or CHF.
COMPARISON: Multiple prior chest radiographs, most recent on ___ and
___ as well as an aortic CTA from ___.
TECHNIQUE: PA and lateral chest radiograph.
FINDINGS: There has been interval increase in right lung base opacity. In
addition, diffuse increase in interstitial markings bilaterally suggests mild
interstitial edema. Cardiomediastinal silhouette is stable. There is no
pleural effusion or pneumothorax. Sternotomy wires are intact. An ICD
monitor is seen overlying the left hemithorax, with a single lead ending in
unchanged position in the inferior wall of the heart.
IMPRESSION: Mild interstitial pulmonary edema. Relative increase in opacity
at the right lung base could be due to underlying infection/pneumonia or
relate to assymetric fluid overload.
|
19959499-RR-72 | 19,959,499 | 29,332,991 | RR | 72 | 2174-07-13 10:40:00 | 2174-07-13 15:40:00 | HISTORY: ___ man with history of aortic stenosis and congestive
heart failure needing aortic valve replacement.
COMPARISON: Abdominal aortic CTA of ___.
TECHNIQUE: MDCT images were obtained from the thoracic inlet to the upper
abdomen. Contrast was not administered. Axial images were interpreted in
conjunction with sagittal and coronal reformats.
FINDINGS:
The thyroid is normal. Axillary, supraclavicular, mediastinal, and hilar
lymph nodes are not pathologically enlarged. The great vessels are normal
caliber. Scattered calcification are present along the anterior surface of
the ascending aorta (e.g. 3:22). Additional scattered calcifications are
present along the aortic arch and descending aorta. There is calcification of
the aortic valve. Calcifications are present within the coronary arteries.
The patient is status post median sternotomy. The wire of a left sided
pacer/defibrillatory terminates in right ventricle. The heart size appears
normal. The pericardium is intact without effusion. The airways are patent to
subsegmental levels.
Two 3 mm right upper lobe nodules are identified (5:89, 112). No focal
consolidation. Bronchiectasis and diffusely increased reticular markings in
the right lower lobe appear worsened since ___. No pleural
effusion or pneumothorax.
The esophagus is unremarkable. There is a moderate hiatal hernia. The
visualized upper abdominal organs are otherwise unremarkable. There is
bilateral gynecomastia.
OSSEOUS STRUCTURES: No focal lytic or sclerotic lesion concerning for
malignancy.
IMPRESSION:
1. Small scattered calcifications are present along the ascending aorta.
2. Right lower lobe interstitial lung disease has mildly worsened since ___. The acuity of this change is unclear and may be chronic.
Recommend correlation with clinical symptoms to exclude an infectious process.
3. Two right upper lobe 3 mm nodules. 12 month followup is indicated if
there is high risk for lung malignancy.
|
19959499-RR-73 | 19,959,499 | 29,332,991 | RR | 73 | 2174-07-15 09:13:00 | 2174-07-15 11:40:00 | ___
Department of Radiology
Standard Report Carotid US
Study: Carotid Series Complete
Reason: Pre op AVR, AS
Findings: Duplex evaluation was performed of bilateral carotid arteries. On
the right there is mild heterogeneous plaque in the ICA. On the left there is
mild heterogeneous plaque seen in the ICA.
On the right systolic/end diastolic velocities of the ICA proximal, mid and
distal respectively are 59/21, 54/14, 65/12 cm/sec. CCA peak systolic
velocity is 52 cm/sec. ECA peak systolic velocity is 68 cm/sec. The ICA/CCA
ratio is 1.3. These findings are consistent with <40% stenosis.
On the left systolic/end diastolic velocities of the ICA proximal, mid and
distal respectively are 62/16, 65/15, 72/20 cm/sec. CCA peak systolic velocity
93 cm/sec. ECA peak systolic velocity is 77 cm/sec. The ICA/CCA ratio is .77.
These findings are consistent with <40% stenosis.
Right antegrade vertebral artery flow.
Left antegrade vertebral artery flow.
Impression: Right ICA <40% stenosis.
Left ICA <40% stenosis.
|
19959691-RR-10 | 19,959,691 | 20,297,285 | RR | 10 | 2117-03-20 09:18:00 | 2117-03-28 11:32:00 | PROCEDURE: CEREBRAL ANGIOGRAPHY
ATTENDING: Dr. ___, who was present for the entire procedure.
ASSISTANT : Dr. ___.
CLINICAL HISTORY: ___ male patient presented with sudden onset of
acute headache to an OSH. A head CT was obtained which was negative for
subarachnoid hemorrhage. However, LP was positive for xanthochromia. Patient
was transferred to ___ for further management. A CTA of the head and neck
was performed which was concerning for a possible 1 mm supraclinoid ICA
aneurysm vs infundibulum. Patient now presents for catheter-based angiography
for further evaluation of this possible abnormality.
TECHNIQUE: Informed consent was obtained from the patient via a ___
speaking interpreter. The patient was brought to the neurointerventional suite
and was prepped and draped in the usual sterile fashion. Intra-arterial access
was achieved by placing a 4 ___ Cordis sheath in the right common femoral
artery using single wall puncture technique. A 4 ___ Berenstein catheter
was advanced into the aortic arch over a Terumo wire coaxially to select the
innominate artery and then the right subclavian artery. Selective
catheterization of the right vertebral artery was carried out, and an
angiographic run was performed. The catheter was then pulled back into the
innominate artery and selective catheterization of the right common carotid
artery was performed followed by an angiographic run of the head. 3-D
rotational angiography via the right common carotid artery was also performed
to better evaluate the vascular anatomy. The catheter was then pulled back
into the arch to select the left common carotid artery, and an angiographic
run was performed. In addition, 3-D rotational angiography via the left common
carotid artery was carried out to better assess the vascular anatomy. Finally,
the left vertebral artery was selectively catheterized using road-map
technique, and an angiographic run of the head was carried out. The diagnostic
catheter and groin sheath were then removed and manual pressure applied until
complete hemostasis was achieved. The patient tolerated the procedure without
complications.
TASKS:
1. Catheterization of the right common femoral artery.
2. Catheterization of the right vertebral artery.
3. Catheterization of the right common carotid artery.
4. 3-D rotational angiography via the right common carotid artery.
5. Catheterization of the left common carotid artery.
6. 3-D rotational angiography via the left common carotid artery.
7. Catheterization of the left vertebral artery.
SEDATION: None.
CONTRAST: Ultravist 110 cc used.
FINDINGS:
RIGHT VERTEBRAL ARTERY: The right vertebral artery injection demonstrated
brisk filling of the posterior circulation including both posterior cerebral
and superior cerebellar arteries as well anterior inferior cerebellar arteries
bilaterally and the right posterior inferior cerebellar artery. There was no
evidence of aneurysm, arteriovenous malformation, or arteriovenous fistula.
The capillary and venous phases were unremarkable.
RIGHT COMMON CAROTID ARTERY: The right common carotid artery injection
demonstrated brisk filling of the ipsilateral ICA and ECA branches with normal
distal runoff. Filling of the right MCA and ACA branches appeared normal and
vascular contours were regular. No significant cross-filling was identified
through the anterior communicating artery. There was no evidence of aneurysm,
arteriovenous malformation, or arteriovenous fistula.The capillary and venous
phases were unremarkable.
LEFT COMMON CAROTID ARTERY: The left common carotid artery injection
demonstrated brisk filling of the ipsilateral ICA and ECA candelabra with
normal distal runoff. Filling of the left MCA and ACA branches appeared normal
and vascular contours were regular. No significant cross-filling was noted
through the anterior communicating artery. A tiny 1 mm triangular shaped
outpouching was visualized at the origin of the left anterior choroidal
artery, better appreciated on 3-D rotational angiography, which was consistent
with a left anterior choroidal artery infundibulum. Otherwise, there was no
evidence of aneurysm, arteriovenous malformation, or arteriovenous fistula.
The capillary and venous phases were unremarkable.
LEFT VERTEBRAL ARTERY: The left vertebral artery injection demonstrated brisk
filling of the posterior circulation including both posterior cerebral and
superior cerebellar arteries as well as anterior inferior cerebellar arteries
bilaterally and the left posterior inferior cerebellar artery. There was no
evidence of aneurysm, arteriovenous malformation, or arteriovenous fistula.
The capillary and venous phases were unremarkable.
IMPRESSION:
Tiny left anterior choroidal artery infundibulum. No evidence of aneurysm, AV
malformation or fistula.
|
19959691-RR-9 | 19,959,691 | 20,297,285 | RR | 9 | 2117-03-20 00:41:00 | 2117-03-20 14:44:00 | STUDY: CTA of the head and CTA of the neck.
CLINICAL INDICATION: History of sudden onset of occipital headache, normal
head CT from an outside institution. LP showing xanthochromia. Evaluate for
possible intracranial aneurysm.
COMPARISON: CTA from an outside institution (___),
dated ___.
TECHNIQUE: Multidetector axial images were obtained through the brain and
neck during the infusion of 70 cc of Optiray intravenous contrast material.
Curved reformats, 3D volume-rendered images and maximum intensity projection
images were obtained and generated on a separate workstation and reviewed.
FINDINGS: There is an equivocal 1 mm posterior outpouching at the left
supraclinoid internal carotid artery, likely consistent with infundibular
dilatation of the anterior choroidal artery, depicted in the high-resolution
reconstructions in sagittal projection (series 500, image #2). No aneurysms
larger than 3 mm in size are identified. The distribution of the vessels
including the anterior, middle and posterior cerebral arteries appears normal.
The review of the outside CT of the head without contrast confirms no acute
intracranial process. The airway appears patent, the visualized paravertebral
structures and soft tissues are grossly unremarkable.
IMPRESSION:
There is a questionable 1 mm posterior outpouching at the left supraclinoid
internal carotid artery, possibly representing a tiny infundibulum at the
anterior choroidal artery as described in detail above. The review of the
outside institution head CT confirms no acute intracranial process. No
aneurysm or vascular malformation is identified.
A preliminary report was provided by Dr. ___ on ___ .
|
19959697-RR-11 | 19,959,697 | 22,344,558 | RR | 11 | 2157-05-07 00:05:00 | 2157-05-07 11:49:00 | EXAMINATION: MR HEAD W/O CONTRAST T9113 MR HEAD
INDICATION: ___ year old man with history of R ICA stenosis and prior strokes
who presents with R sideded weakness, evaluate for stroke
TECHNIQUE: Sagittal T1 weighted imaging was performed. Axial imaging was
performed with gradient echo, FLAIR, diffusion, and T2 technique were then
obtained.
COMPARISON None.
FINDINGS:
There is no evidence of hemorrhage, edema, masses, mass effect, midline shift
or infarction. The ventricles and sulci are prominent for the patient's age,
suggesting cortical volume loss. No diffusion abnormalities are detected.
The major vascular flow voids are present and demonstrate normal distribution.
The paranasal sinuses and mastoid air cells are clear, the orbits are
unremarkable.
IMPRESSION:
1. No acute intracranial abnormality.
|
19959697-RR-12 | 19,959,697 | 22,344,558 | RR | 12 | 2157-05-07 09:44:00 | 2157-05-07 11:38:00 | INDICATION: Evaluate for aspiration in a patient with prior stroke.
TECHNIQUE: Oropharyngeal swallowing videofluoroscopy was performed in
conjunction with the speech and swallow division. Multiple consistencies of
barium were administered.
COMPARISON: None.
FINDINGS:
Barium passes freely through the oropharynx and esophagus without evidence of
obstruction. There is a large amount of aspiration of thin and nectar thick
liquids.
IMPRESSION:
Large amount of aspiration of thin and nectar thick liquids.
Please refer to the speech and swallow division note in OMR for full details,
assessment, and recommendations.
|
19959697-RR-13 | 19,959,697 | 22,344,558 | RR | 13 | 2157-05-09 01:33:00 | 2157-05-09 08:16:00 | EXAMINATION: CT HEAD W/O CONTRAST Q111 CT HEAD
INDICATION: ___ year old man with history of stroke status post right CEA on
___ with subsequent mild right sided weakness, now with markedly increased
right sided weakness and severe headache. Evaluate foracute intracranial
hemorrhage or large territorial infarct.
TECHNIQUE: Contiguous axial images of the brain were obtained without
contrast.
DOSE: This study involved 3 CT acquisition phases with dose indices as
follows:
1) CT Localizer Radiograph
2) CT Localizer Radiograph
3) Sequenced Acquisition 18.0 s, 19.3 cm; CTDIvol = 51.9 mGy (Head) DLP =
1,003.4 mGy-cm.
Total DLP (Head) = 1,003 mGy-cm.
COMPARISON: ___ noncontrast brain MRI.
___ contrast head neck CTA.
FINDINGS:
There is no evidence of no evidence of infarction, hemorrhage, edema, or
mass. Prominent ventricles and sulci are preserved. Atherosclerotic vascular
calcifications are noted of bilateral cavernous portions of internal carotid
arteries.
There is no evidence of fracture. The visualized portion of the mastoid air
cells, and middle ear cavities are clear. The visualized portion of the orbits
are unremarkable. Again is noted nonspecific suboccipital soft tissue
induration of fat at the midline (see ___. Minimal left maxillary sinus
mucosal thickening is present.
IMPRESSION:
1. No acute intracranial process.
2. Please note MRI of the brain is more sensitive for the detection of acute
infarct.
3. Nonspecific induration of suboccipital soft tissues may represent
postoperative changes. However other etiologies are not excluded the basis
examination. Recommend clinical correlation and correlation with direct
examination.
NOTIFICATION: Findings were communicated to Dr. ___ at 1:56 a.m. on ___ in person.
|
19959697-RR-23 | 19,959,697 | 24,526,526 | RR | 23 | 2158-04-17 11:04:00 | 2158-04-17 12:06:00 | EXAMINATION: Chest radiograph
INDICATION: ___ with picc line in place. Verify picc in correct place.
TECHNIQUE: Chest PA and lateral
COMPARISON: Chest radiograph ___
FINDINGS:
The lungs are well inflated with mild vascular congestion. No focal opacity.
No pleural effusion or pneumothorax. Heart size, mediastinal contour, and
hila are unremarkable. A right PICC tip is in the low SVC.
Limited assessment of the osseous structures are notable for mild multilevel
degenerative changes of thoracolumbar spine.
IMPRESSION:
1. Right PICC tip in low SVC.
2. Mild vascular congestion.
|
19959697-RR-24 | 19,959,697 | 24,526,526 | RR | 24 | 2158-04-17 11:04:00 | 2158-04-17 12:03:00 | EXAMINATION: ANKLE (AP, MORTISE AND LAT) LEFT
INDICATION: ___ with open wound on Lateral L ankle, purulent. Assess for
fracture.
TECHNIQUE: Frontal, oblique, and lateral view radiographs of left ankle
COMPARISON: Left ankle radiograph ___. Left MR ___ ___
FINDINGS:
There is evidence of previously removed surgical hardware with lucencies
within the distal tibia and calcaneus. There is diffusely abnormal
morphologic appearance of the calcaneus which is foreshortened. Cortical
irregularity at its inferior margin is also noted. There is loss of discrete
cortical margin of the talar neck best seen on the lateral view. The
navicular bone appears abnormal in morphology and foreshortened though no
discrete cortical irregularity identified on these ankle films. There is
calcification adjacent to the fibula laterally. Diffuse soft tissue swelling
is noted. Ankle mortise is preserved on these nonstress views.
IMPRESSION:
1. Findings worrisome for osteomyelitis with cortical irregularity along the
inferior calcaneus, talar neck and new lateral malleolar soft tissue swelling
with an irregular 0.8 cm ossific density adjacent to lateral fibula.
2. Abnormal contour of the calcaneus raising concern for underlying fracture.
3. Abnormal contour of the navicular bone, not fully assessed on this exam.
RECOMMENDATION(S): Consider dedicated MR for further evaluation for acute
osteomyelitis.
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Subsets and Splits